title: The Association of Patient Chronic Disease Burden and Self-Management Requirements With Shared Decision Making in Primary Care Visits.
abstract: BACKGROUND
  Shared decision making (SDM) is associated with positive health outcomes and may be particularly relevant for patients with chronic disease.
  
  
  OBJECTIVE
  To investigate whether (1) patients with chronic diseases, particularly those requiring self-management, are more likely to engage in SDM behaviors than patients without chronic diseases and (2) patients with chronic diseases are more likely to have theirphysiciansengage them in SDM.
  
  
  METHODS
  A cross-sectional study of patients who were enrolled in a randomized controlled trial to improve patient-physician communication.
  
  
  METHODS
  Adult patients with hypertension at community health clinics in Baltimore, Maryland.
  
  
  METHODS
  We used multivariable regression models to examine the associations of the following predictor variables: (1) chronic disease burden and (2) diseases requiring self-management with the following outcome variables measuring SDM components: (1) patient information sharing, (2) patient decision making, and (3) physician SDM facilitation.
  
  
  RESULTS
  Patients with greater chronic disease burden and more diseases requiring self-management reported more information sharing (β = .07,P= .03 and β = .12,P= .046, respectively) and decision making (β = .06,P= .02 and β = .21,P< .001) as did patients who reported poor general health. Physician facilitation of SDM was not associated with chronic disease burden or with diseases requiring self-management but was associated with higher patient income.
  
  
  CONCLUSIONS
  Patients with chronic diseases, particularly those requiring self-management, may be more likely to engage in SDM behaviors, but physicians may not be more likely to engage such patients in SDM. Targeting patients with chronic disease for SDM may improve health outcomes among the chronically ill, particularly among vulnerable patients (eg, minorities, low-income patients) who suffer disproportionately from such conditions.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA ; Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA ; Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA ; Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, IL, USA ; Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, IL, USA.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Peek
authors.affiliation: Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA ; Department of Health Studies, University of Chicago, Chicago, IL, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Drum
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA ; Department of Epidemiology and Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA ; Department of Medicine, Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
keywords: chronic diseases; patient self-management; patient/provider communication; shared decision making