[Shared decision making even for complex systemic autoimmune diseases such as Systemic Lupus Erythematosus (SLE)?]

OBJECTIVE: The treatment of systemic autoimmune diseases, such as systemic lupus erythematosus (SLE) is an enormous challenge for all involved due to the complexity. This study investigated whether shared decision making (SDM) can advantageously be implemented in such a situation.

METHOD: To answer this question qualitative group surveys were carried out with rheumatologists according to the standardized method of K&P Psychodrama®. A total of 41 German rheumatologists who had been invited by GlaxoSmithKline (GSK) Germany participated in 2 meetings over a complete day in 2012 and 2013 as well as 2 half-day meetings in 2013, which were carried out by K&A BrandResearch.

RESULTS: In general rheumatologists were appreciative of their discipline because of the broadly spread field of work, the possibility to "tinker" and the increasing spectrum of effective forms of therapy. Negative points were the increasing amount of work, particularly due to increasing bureaucratic processes, demanding and unreasonable patients. These stressful situations were compensated by treatment of indications that can easily be diagnosed and treated; however, this is contrasted by indications which are insufficiently palpable for patients and physicians alike and this includes SLE. Fear is at the forefront of the interaction, initially by the patient and during the course of treatment ultimately by the physician. In this context, a further fear factor between both parties is the medications that are available for other diseases as support for physician and patient. The necessary emotional distancing of the physician is achieved by a switch to the purely professional level. Personal emotions are depressed by avoidance of empathy.

CONCLUSION: The rheumatologists in this study principally showed excellent prerequisites for SDM; however, for illnesses such as SLE there is a clear need for action on the part of physicians before SDM can be advantageous for affected patients.