title: Minorities with lupus nephritis and medications: a study of facilitators to medication decision-making.
abstract: BACKGROUND
  Medication decision-making poses a challenge for a significant proportion of patients. This is an even more challenging for patients who have complex, rare, immune conditions that affect them at a young age and are associated with the use of life-long treatment, perceived by some as having significant risk of side effects and toxicity.
  
  
  BACKGROUND
  The aim of our study was to examine the perspectives of women with lupus nephritis on facilitators to medication decision-making.
  
  
  METHODS
  We used the nominal group technique (NGT), a structured formative process to elicit patient perspectives. An NGT expert moderated eight patient group meetings. Participants (n = 52) responded to the question "What sorts of things make it easier for people to decide to take the medicines that doctors prescribe for treating their lupus kidney disease?" Patients nominated, discussed, and prioritized facilitators to medication decisional processes.
  
  
  RESULTS
  Fifty-two women with lupus nephritis participated in eight NGT meetings (27 African-American, 13 Hispanic, and 12 Caucasian). Average age was 40.6 years (standard deviation (SD) = 13.3), and disease duration was 11.8 years (SD = 8.3); 36.5 % obtained at least a college education, and 55.8 % had difficulty in reading health materials. Patients generated 280 decision-making facilitators (range of 26 to 42 per panel). Of these, 102 (36 %) facilitators were perceived by patients as having relatively more influence in decision-making processes than others. Prioritized facilitators included effective patient-physician communication regarding benefits/harms, patient desire to live a normal life and improve quality of life, concern for their dependents, experiencing benefits and few/infrequent/no harms with lupus medications, and their affordability. Relative to African-Americans, Caucasian and Hispanic patients endorsed a smaller percentage of facilitators as influential. Level of agreement with which patients within panels independently agreed in their selections of the three most influential facilitators ranged from 33 % to 60 %.
  
  
  CONCLUSIONS
  We identified facilitators to lupus medication decision-making. This information will be used to populate a decision aid for lupus nephritis.
authors.affiliation: Medicine Service, Birmingham VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, USA. jassingh@uab.edu.|Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. jassingh@uab.edu.|Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA. jassingh@uab.edu.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, 1705 University Blvd, Birmingham, AL, 35233, USA. hyqu@uab.edu.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Qu
authors.affiliation: Department of MedicineUniversity of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. jinoos.yazdany@ucsf.edu.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. wchatham@uab.edu.
authors.forename: Winn
authors.initials: W
authors.lastname: Chatham
authors.affiliation: Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, 1705 University Blvd, Birmingham, AL, 35233, USA. shewchuk@uab.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Shewchuk
mesh_terms: D000328:Adult; D001741:Black or African American; D003657:Decision Making; D004358:Drug Therapy / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life; D011795:Surveys and Questionnaires; D044465:White People