title: The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter.
abstract: BACKGROUND
  Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles.
  
  
  METHODS
  Based on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development.
  
  
  RESULTS
  Three iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians.
  
  
  CONCLUSIONS
  The process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.
authors: Department of Medicine, University of California, San Francisco, CA, USA. Jennifer.Barton@va.gov.|Division of Hospital & Specialty Medicine, Portland Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA. Jennifer.Barton@va.gov.
authors: Jennifer L
authors: JL
authors: Barton
authors: Department of Medicine, University of California, San Francisco, CA, USA. Christopher.Koenig@ucsf.edu.
authors: Christopher J
authors: CJ
authors: Koenig
authors: Department of Medicine, University of California, San Francisco, CA, USA. Gina.Evans-Young@ucsf.edu.|Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA. Gina.Evans-Young@ucsf.edu.
authors: Gina
authors: G
authors: Evans-Young
authors: Department of Medicine, University of California, San Francisco, CA, USA. Laura.Trupin@ucsf.edu.|Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA. Laura.Trupin@ucsf.edu.
authors: Laura
authors: L
authors: Trupin
authors: , San Francisco, CA, USA. jennie.e.anderson@gmail.com.
authors: Jennie
authors: J
authors: Anderson
authors: , San Francisco, CA, USA. drzeos@gmail.com.
authors: Dana
authors: D
authors: Ragouzeos
authors: , Brooklyn, NY, USA. maggie.breslin@gmail.com.
authors: Maggie
authors: M
authors: Breslin
authors: , San Francisco, CA, USA. future.timothy@gmail.com.
authors: Timothy
authors: T
authors: Morse
authors: Department of Medicine, University of California, San Francisco, CA, USA. dschillinger@medsfgh.ucsf.edu.
authors: Dean
authors: D
authors: Schillinger
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA. Montori.Victor@mayo.edu.
authors: Victor M
authors: VM
authors: Montori
authors: Department of Medicine, University of California, San Francisco, CA, USA. Ed.Yelin@ucsf.edu.|Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA. Ed.Yelin@ucsf.edu.
authors: Edward H
authors: EH
authors: Yelin
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003657:Decision Making; D003661:Decision Support Techniques; D057220:Health Literacy; D006801:Humans
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