title: Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context.
abstract: Numerous factors can impede or facilitate patients' medication decision-making and adherence to physicians' recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach.
  
  
  
  We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis.
  
  
  
  A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders' perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for "me," 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics.
  
  
  
  Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication.
authors.affiliation: University of Alabama, Birmingham.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Qu
authors.affiliation: University of Alabama, Birmingham.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Shewchuk
authors.affiliation: University of Alabama, Birmingham.
authors.forename: Graciela
authors.initials: G
authors.lastname: Alarcón
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.affiliation: Healthy Motivation, Santa Barbara, California.
authors.forename: Amye
authors.initials: A
authors.lastname: Leong
authors.affiliation: University of California, San Francisco.
authors.forename: Maria
authors.initials: M
authors.lastname: Dall'Era
authors.affiliation: University of California, San Francisco.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.affiliation: Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
mesh_terms: D016000:Cluster Analysis; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D010465:Perception; D010817:Physician-Patient Relations