TOPLINE:

The implementation of a decision aid for systemic lupus erythematosus (SLE) in US clinics improved patient outcomes, including reduced decisional conflict and enhanced shared decision-making. Over 80% found the aid balanced for information on immunosuppressive drugs vs glucocorticoids, and outcomes remained favorable over 6 months.

METHODOLOGY:

• Researchers conducted a prospective implementation study across 15 rheumatology clinics in the US (2019-2023) to assess the association between the administration of an evidence-based patient decision aid for SLE and patient and process outcomes.
• They included 1895 adults with SLE (mean age, 44.7 years; 93.3% of 1855 were female; 45.1% of 1832 were African American) who viewed either a full or lite version of the SLE decision aid via a touch screen tablet, website, or smartphone app, tailored as per disease activity, during regular clinic visits.
• The full SLE patient decision aid was for those with active disease (n = 817), covering information on SLE, harms and benefits of immunosuppressive medications, biologics, and reproductive health, whereas the lite version was for less active cases (n = 1075) and excluded some details on immunosuppressive drugs or biologics and the section on reproductive health and related components.
• Effects of using the decision aid on patient decisional conflict, shared decision-making, communication between patient and provider, and perceived acceptability and feasibility were assessed.
• Validated surveys were completed at baseline and at 3-month and 6-month visits, either in person or via telemedicine.

TAKEAWAY:

• The Preparation for Decision Making scale score was high at baseline, with a mean of 74.44. The decision aid was perceived as balanced by 81.4% of participants, providing equitable information on immunosuppressive drugs vs glucocorticoids.
• Participants reported high feasibility of the decision aid, and patient outcomes improved with the SLE decision aid, showing a low mean score on the Low-Literacy Decisional Conflict Scale at baseline (19.48) and consistent results at 3 and 6 months.
• The mean CollaboRATE score, indicating patient involvement in shared decision-making, was high at baseline (25.17) and remained stable over time.
• Patient-provider care and communication was rated high, with mean Interpersonal Processes of Care Short Form scores around 82 at baseline, 3 months, and 6 months, showing consistent quality. High levels of satisfaction were reported by patients regarding the ease of using the SLE decision aid.

IN PRACTICE:

“The SLE patient decision aid can improve patients’ knowledge of the key risks and benefits of the most commonly used SLE medications without a commercial bias and can encourage patient-provider dialogue on treatment,” the authors of the study wrote. “The SLE patient decision aid seems feasible for widespread dissemination to rheumatology care settings in the USA and other countries. A focus on effective strategies for durable and self-sustained widespread implementation is needed,” they added.

SOURCE:

The study was led by Jasvinder A. Singh, MBBS, MPH, Medicine Service, Michael E. DeBakey Veterans Affairs Medical Center in Houston. It was published online on September 17, 2025, in The Lancet Rheumatology.

LIMITATIONS:

The study’s observational design may introduce confounding and selection bias. Digital accessibility and literacy were not assessed, potentially excluding some participants. The refusal of 110 patients to participate limited the generalizability of the findings. Not all participants completed every follow-up survey, so long-term data were available only for those who did.

DISCLOSURES:

The study was supported by the Patient-Centered Outcomes Research Institute. Some authors disclosed receiving consultancy fees, speaker fees, honoraria, and institutional research support from various organizations; holding stock options in several companies; serving on advisory boards; and having other ties with various organizations. One author reported receiving consultancy fees from Medscape Medical News and WebMD.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.