title: Doctor-patient concordance during HIV treatment switching decision-making.
abstract: OBJECTIVE
  The aim of the study was to explore levels of doctor-patient concordance during the making of decisions regarding HIV treatment switching and stopping in relation to patient health-related outcomes.
  
  
  METHODS
  Adult patients attending five HIV clinics in the United Kingdom were requested to complete the study questionnaire, which included a Concordance Scale, and measures of symptoms [Memorial Symptom Assessment Short Form (MSAS) index], quality of life (EuroQol), satisfaction, adherence and sexual risk behaviour. Clinical health measures (HIV viral load and CD4 cell count) were also obtained. A total of 779 patients completed the questionnaire, giving a response rate of 86%; of these 779 patients, 430 had switched or stopped their HIV treatment and were thus eligible for inclusion. Of these patients, 217 (50.5%) fully completed the Concordance Scale.
  
  
  RESULTS
  Concordance levels were high (88% scored between 30 and 40 on the scale; score range 10-40). Higher concordance was related to several patient outcomes, including: better quality of life (P=0.003), less severe and burdensome symptom experience (lower MSAS-physical score, P=0.001; lower MSAS-psychological score, P=0.008; lower MSAS-global distress index score, P=0.011; fewer symptoms reported, P=0.007), higher CD4 cell count (at baseline, P=0.019, and 6-12 months later, P=0.043) and greater adherence (P=0.029).
  
  
  CONCLUSIONS
  High levels of doctor-patient concordance in HIV treatment decision-making are associated with greater adherence and better physical and psychological functioning. More research is needed to establish a causal relationship between concordance and these outcomes.
authors.affiliation: University College London, London, UK. c.clucas@ucl.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Clucas
authors.forename: R
authors.initials: R
authors.lastname: Harding
authors.forename: F C
authors.initials: FC
authors.lastname: Lampe
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.forename: H L
authors.initials: HL
authors.lastname: Date
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Edwards
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.forename: L
authors.initials: L
authors.lastname: Sherr
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires