Physician–patient interaction and medication adherence in lupus nephritis

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The quality of physician–patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient–doctor depth of relationship, patient–doctor quality of relationship, interpersonal trust in a physician and illness perceptions. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; P = 0.05); (b) timeline cyclical (B = –0.89, Wald 4.95, 95% CI 0.19, 0.90; P &lt; 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; P &lt; 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; P &lt; 0.01). A further mediation analysis showed that patient–doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; P &lt; 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; P &lt; 0.001) and patient–doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; P &lt; 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients’ illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient–doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis. </jats:p></jats:sec>

Patient experiences and strategies for coping with SLE: A qualitative study

“…6 A single-center questionnaire study of patients with SLE nephritis in the United Kingdom noted that better patient–doctor relationships predicted good medication adherence; conversely, lower trust was associated with greater risk of anxiety and depression. 9 Patient communication has also been linked to morbidity, as shown in a study by Ward et al describing a lower rate of permanent organ damage in patients with SLE who asked more questions, were more assertive, and who expressed more concern during their visits. 10 Communication and provider trust is especially important for patients with cSLE who are transitioning between medical teams.…”

Trust in the attending rheumatologist, health-related hope, and medication adherence among Japanese patients with systemic lupus erythematosus: the TRUMP2-SLE project

“…[9] A study in the UK involving ethnically diverse patients with SLE indicated an association between trust in one's physician and medication adherence; however, the association might have been confounded by economic status, basic health literacy, and beliefs regarding medications. [10] Furthermore, both studies did not consider the impact of physician-patient racial mismatches. [3] Meanwhile, this study provides a more robust finding because it demonstrated the association between trust in one's physician and medication adherence after adjusting for more confounding factors among patients who comprised largely of a single ethnic group matched to their physicians.…”

“…[9, 10] Moreover, the effects of a physician−patient racial mismatch on distrust have not been considered. [3, 9, 10] Separately, having hope is an important coping strategy and a useful means of navigating the uncertainty of the disease course,[11] and is proposed as a component of patient-centered care in chronic illness. [12] Hope has been identified as an important source of motivation for medication adherence in other chronic diseases.…”

“…[7] Despite the recent emphasis on trust in one's physician, which is central to the physician-patient relationship, as a source of empowerment in rheumatology, [8] a possible association between loss of trust in one's physician and medication adherence has been reported with only few conflicting results. [9,10] Moreover, the effects of a physician−patient . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

“…[7] Despite the recent emphasis on trust in one's physician, which is central to the physician-patient relationship, as a source of empowerment in rheumatology, [8] a possible association between loss of trust in one's physician and medication adherence has been reported with only few conflicting results. [9,10] Moreover, the effects of a physician−patient racial mismatch on distrust have not been considered. [3,9,10] Separately, having hope is an important coping strategy and a useful means of navigating the uncertainty of the disease course, [11] and is proposed as a component of patient-centered care in chronic illness.…”