J Allergy Clin Immunol Pract. 2021 Nov 13:S2213-2198(21)01259-9. doi: 10.1016/j.jaip.2021.10.068. Online ahead of print.
ABSTRACT
BACKGROUND: Autonomy is the ability of patients to make informed medical decisions. Autonomy is rooted in disease state understanding. Medical ethics, especially the principle of autonomy, plays an important role in healthcare delivery when caring for diverse populations.
OBJECTIVE: We sought to identify patient characteristics that influence autonomy.
METHODS: 295 adults with moderate to severe asthma completed two surveys at the beginning of a one year randomized clinical trial. The Navigating Ability and Inhaled Corticosteroids Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 10-105. Linear regression was performed on the derived autonomy score predicted by patient baseline characteristics.
RESULTS: Comparison revealed statistically significant differences in baseline autonomy scores in patients who reported Spanish as their primary language (p=0.01), patients with diabetes (p=0.01), and those with depressive symptoms (p=0.03) at -11.4 (95% CI, -20.5, -2.3), -4.8 (95% CI, -8.3, -1.3), and -3.1 (95% CI, -5.9, -0.3) points respectively. Non-Hispanic White participants on average were found to have 8.2 (95% CI, 4.5, 12.0) points higher autonomy scores compared to non-Hispanic Black participants (Bonferroni adjusted p<0.01). Patients with higher functional health literacy had higher autonomy scores (coefficient=0.24, 95% CI, 0.1, 0.4, p<0.01) CONCLUSIONS: Autonomy is associated with comorbidities, demographics, and literacy. These results may reflect differences in social, educational, and economic opportunities encountered by patients. Further investigation is needed to assess and understand how socioeconomic and educational factors influence autonomy. By identifying differences in autonomy based on baseline patient characteristics, this project serves as an initial step in adjusting current and developing new treatment guidelines and interventions to improve patient autonomy.
PMID:34785390 | DOI:10.1016/j.jaip.2021.10.068
