Eshelman School of Pharmacy, University of North Carolina at Chapel Hill.
University of Texas Southwestern, Dallas.
Arthritis Care Res (Hoboken). 2022 Jan;74(1):142-150. doi: 10.1002/acr.24421. Epub 2021 Dec 22.
To evaluate the effectiveness of 2 interventions, including the DrugFactsBox format for presenting written medication information and the SMART (Strategic Memory Advanced Reasoning Training) program designed to enhance gist (i.e., "bottom-line" meaning) reasoning ability.
We used a 2 × 2 factorial research design. A total of 286 patients with rheumatoid arthritis were randomly assigned to 1 of 4 groups, including DrugFactsBox with the SMART program, DrugFactsBox without the SMART program, other consumer medication information (CMI) with the SMART program, and other CMI without the SMART program. Data were collected via telephone interviews and online questionnaires at 4 time points, including baseline and 6-week, 3-month, and 6-month time points following baseline. The primary outcome variable was informed decision-making, which was defined as making a value-consistent decision concerning use of disease-modifying antirheumatic drugs based on adequate knowledge.
We found no main effects for the 2 interventions, either alone or in combination. However, there was a significant interaction between assignment to the SMART/no SMART groups and informed decision-making at baseline. Among participants in the SMART groups who did not meet the criteria for informed decision-making at baseline, 42.5% met the criteria at the 6-month follow-up, compared to 23.6% of participants in the no SMART groups (mean difference 18.9 [95% confidence interval 5.6, 32.2]; P = 0.007). This difference was driven by increased knowledge in the SMART groups. Among participants who met the criteria for informed decision-making at baseline, the difference between the SMART and no SMART groups was not statistically significant.
Participation in a theory-driven program to enhance gist reasoning may have a beneficial effect on informed decision-making among patients with inadequate knowledge concerning therapeutic options.
评估 2 种干预措施的效果，包括用于呈现书面药物信息的 DrugFactsBox 格式和旨在增强主旨（即“底线”含义）推理能力的 SMART（策略性记忆高级推理训练）计划。
我们采用了 2×2 析因设计。共有 286 名类风湿关节炎患者被随机分配到 4 组中的 1 组，包括 DrugFactsBox 联合 SMART 计划、DrugFactsBox 不联合 SMART 计划、其他消费者药物信息（CMI）联合 SMART 计划和其他 CMI 不联合 SMART 计划。数据通过电话访谈和在线问卷在 4 个时间点收集，包括基线和 6 周、3 个月和 6 个月。主要结局变量是知情决策，定义为基于充分知识对使用疾病修正抗风湿药物做出价值一致的决策。
我们没有发现这 2 种干预措施（单独或联合使用）的主要效果。然而，在 SMART/no SMART 分组的分配和基线时的知情决策之间存在显著的交互作用。在基线时不符合知情决策标准的 SMART 组参与者中，有 42.5%在 6 个月随访时符合标准，而在 no SMART 组参与者中，这一比例为 23.6%（平均差异 18.9[95%置信区间 5.6，32.2]；P=0.007）。这种差异是由于 SMART 组知识的增加。在基线时符合知情决策标准的参与者中，SMART 组和 no SMART 组之间的差异没有统计学意义。
参与以理论为基础的增强主旨推理的计划可能对治疗选择知识不足的患者的知情决策产生有益影响。
