5 years ago

The perspectives of medical specialists from different disciplines on the management of systemic lupus erythematosus: an interview study

Ming-Wei Lin, Peter Tugwell, Sean G O'Neill, David J Tunnicliffe, Jonathan C Craig, Davinder Singh-Grewal, Daniel Sumpton, Shilpanjali Jesudason, Allison Tong
Objectives Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple organ systems, with specialists from many disciplines often involved, which may lead to inconsistent care. We aimed to describe the attitudes and perspectives of specialists from different medical disciplines on the management of people with SLE. Methods Face-to-face, semi-structured interviews were conducted with rheumatologists (n=16), nephrologists (n=16), and immunologists (n=11) providing care to adults with SLE from 19 centers across Australia in 2015. All interviews were transcribed and analyzed thematically. Results Five themes were identified: uncertainties in judgments (hampered by unknown and unclear etiology, inapplicable evidence, comprehending information dispersion); reflexive responses (anchoring to specialty training, anticipating outcomes, avoiding disaster, empathy for the vulnerable); overarching duty to patients (achieving patient priorities, maximizing adherence, controlling the disease, providing legitimate information, having adequate and relevant expertise); safeguarding professional opportunities (diversifying clinical skills, protecting colleagues’ interests); and optimizing access to treatment (capitalizing on multidisciplinary care, acquiring breakthrough therapies). Conclusions Specialists strive to deliver evidence-informed patient-centered care, but recognize they are anchored by their training. To overcome uncertainties in clinical management due to lack of high-quality evidence and specialty silo structures, specialists translated evidence from other disease settings and collaborated with other specialists in routine care. Developing robust evidence, tools to support evidence informed decisions, and multidisciplinary shared-care pathways may improve the management of people with this complex disease. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23469

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