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Attitudes about principle of autonomy in Hispanic patients from a dynamic early rheumatoid arthritis cohort

1, 2, 3, 4

 

  1. Department of Immunology and Rheumatology. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez, Ciudad de México, México. virtichu@gmail.com
  2. Department of Immunology and Rheumatology. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez, Ciudad de México, México.
  3. Department of Immunology and Rheumatology. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez, Ciudad de México, México.
  4. Centro de Investigación en Bioética, Universidad Panamericana, Ciudad de México, México.

CER11486
2019 Vol.37, N°4
PI 0608, PF 0614
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PMID: 30620286 [PubMed]

Received: 28/06/2018
Accepted : 10/09/2018
In Press: 20/12/2018
Published: 27/06/2019

Abstract

OBJECTIVES:
In 2004, we began assembling an incidental cohort of patients with recent-onset rheumatoid arthritis (RA). In February 2018, we performed a cross-sectional study with the objective to investigate patients’ attitudes/knowledge regarding the autonomy principle.
METHODS:
Patients currently attending the cohort (n=146) were invited to participate. A 4-dimensional questionnaire was administered, and a rheumatologic evaluation performed in the 143 patients who agreed to participate. Dimension-4 (D-4) included 7 multiple-choice (strongly agree-strongly disagree) sentences, 3 of which were related to patients’ rights/obligations about health-related decisions (group-1), and 4 additional sentences challenged physician’s recommendations (group-2). The D-4 score was considered a surrogate of knowledge autonomy (KA). Additionally, the surveyor scored KA with a Likert scale (poor, borderline and superior), and a cut-off point for poor KA was set using Borderline methodology. Mann-Whitney U-tests and logistic regression analysis were used. The study received IRB approval.
RESULTS:
At the time the questionnaire was administered, mean (±SD) patient age was 46.9 (±13.6) years, and median (interquartile range) cohort follow-up time was 8.8 (4.3-11.9) years. Fifty-one patients (35.6%) had poor KA; increased age (OR: 0.97, 95% CI: 1.004-1.063, p=0.023) was associated with better KA. Patients more frequently agreed-strongly agreed with group-1 sentences than they did with group-2 sentences (86.7% vs. 58%, p≤0.001). The results were reproduced in the subpopulations with sufficient KA (98.9% vs. 88%, p=0.007) and poor KA for patients in whom the gap was extreme (64.9% vs. 3.9%, p≤0.001).
CONCLUSIONS:
Hispanic RA patients’ sense of autonomy suggests paternalism in the physician-patient relationship.

Rheumatology Article