PLoS Medicine (May 2019)

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

  • Jasvinder A Singh,
  • Liana Fraenkel,
  • Candace Green,
  • Graciela S Alarcón,
  • Jennifer L Barton,
  • Kenneth G Saag,
  • Leslie M Hanrahan,
  • Sandra C Raymond,
  • Robert P Kimberly,
  • Amye L Leong,
  • Elyse Reyes,
  • Richard L Street,
  • Maria E Suarez-Almazor,
  • Guy S Eakin,
  • Laura Marrow,
  • Charity J Morgan,
  • Brennda Caro,
  • Jeffrey A Sloan,
  • Bochra Jandali,
  • Salvador R Garcia,
  • Jennifer Grossman,
  • Kevin L Winthrop,
  • Laura Trupin,
  • Maria Dall'Era,
  • Alexa Meara,
  • Tara Rizvi,
  • W Winn Chatham,
  • Jinoos Yazdany

DOI
https://doi.org/10.1371/journal.pmed.1002800
Journal volume & issue
Vol. 16, no. 5
p. e1002800

Abstract

Read online

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525.