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Risk communication in rheumatoid arthritis
Liana Fraenkel1, Sidney Bogardus, John Concato
1VA Connecticut Healthcare System, West Haven, Connecticut 06520-8031, USA. Liana.Fraenkel@yale.edu
The Journal of Rheumatology
|March 1, 2003
Summary
Many rheumatoid arthritis patients consider certain adverse effects unacceptable, even at very low risks. This suggests some risks are treated as "protected values," potentially impacting treatment decisions.
Area of Science:
- Rheumatology
- Clinical Psychology
- Decision Science
Background:
- Some individuals hold
- protected values
- that should not be subject to trade-offs.
- Patients with rheumatoid arthritis (RA) face treatment decisions involving risks of adverse effects (AE).
Purpose of the Study:
- To investigate whether RA patients perceive the risk of certain AE as
- protected values
- —unacceptable regardless of probability.
Main Methods:
- RA patients rated their willingness to risk 17 AE on a visual analog scale (0=never willing, 100=definitely willing).
- Participants then assessed their willingness to take medication as AE risks were progressively reduced.
- Risk reduction levels ranged from actual risk down to 1 in 100,000.
Main Results:
- 32-39% of patients rejected even reduced risks of reversible cosmetic or discomfort-related AE.
- 41-45% rejected reduced risks of irreversible damage AE.
- 66% refused to accept a 1 in 100,000 risk of cancer.
Conclusions:
- A significant proportion of RA patients treat highly concerning AE as
- protected values
- unwilling to accept even minimal risks.
- This perception may lead to suboptimal clinical decision-making regarding medication.
- Understanding protected values is crucial for effective patient-physician communication and treatment adherence.