Clinical Rheumatology

, Volume 38, Issue 11, pp 3217–3225 | Cite as

Shared decision-making aid for juvenile idiopathic arthritis: moving from informative patient education to interactive critical thinking

  • Yasser El MiedanyEmail author
  • M. El Gaafary
  • H. Lotfy
  • N. El Aroussy
  • D. Mekkawy
  • S. I. Nasef
  • Y. Farag
  • S. Almedany
  • Ghada Wassif
  • on behalf of PRINTO Egypt
Original Article



To develop and evaluate an illustrated, stand-alone, interactive evidence-based shared decision making (SDM) aid for JIA children; its ability to produce positive perceived involvement of JIA patients in their own management and its impact on their adherence to therapy, school absenteeism and treatment outcomes.


The SDM aid was developed to offer information about the disease, risks and benefits of treatment. A multidisciplinary team defined SDM criteria based on international standards (IPDAS). Eight categories emerged as highly important for SDM. Each category was supported by simple illustrations in an interactive style. At the end of each category, the child is asked to make a decision in view of the information given. Ninety-four JIA children were provided with the tool, in a randomised controlled study, in comparison to a control group of 95 JIA patients treated according to standard protocols.


A total of 97.5% of the study children reported comprehensibility of more than 90%. The patients’ adherence to therapy was significantly (p < 0.01) higher in the SDM group, whereas stopping DMARDs for intolerability was significantly higher in the control group at 12 months of treatment. There was a significant improvement in the patient-reported outcomes in the SDM group, and absence from school was significantly higher in the control group (p < 0.01).


The developed SDM aid offered the children evidence-based information about the pros and cons of treatment options and improved their understanding of the disease and their ability to make an informed decision that is reflected on their adherence to therapy and better treatment outcomes.

Key Points

• This work represents the second generation of shared decision-making tools.

• The developed tool adopts an interactive style and enhances critical thinking, giving the patients the facility of making their own decision regarding their management.

• The work gives an example of core domain set of outcomes which can be used for shared decision-making interventions.


Adherence Arthritis Interactive thinking JIA Shared decision making 



We express thanks to all participants, our colleagues, research assistants and nurses for their cooperation and help to bring this research to its final conclusions. Special thanks to Mr. Ali El Miedany (DGS-Dartford, England) for his contribution to the illustration choices and data entry.

Author’s contribution

All authors contributed in the study methodology, analysis and interpretation of the data and outcomes as well as the manuscript writing, reading and approval of the final version. Prof. Wassif shared in the illustrations selection process and visual aids development. Prof. El Gaafary carried out statistical analysis and reviewed the methodology and results sections. Y. El Miedany developed the figures.

Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Rheumatology and RehabilitationSchool of Medicine Ain Shams UniversityCairoEgypt
  2. 2.RheumatologyMedway Foundation TrustGillinghamUK
  3. 3.Community and Public HealthSchool of Medicine Ain Shams UniversityCairoEgypt
  4. 4.PediatricsSchool of Medicine Cairo UniversityCairoEgypt
  5. 5.Rheumatology and RehabilitationSchool of Medicine Suez Canal UniversityIsmailiaEgypt
  6. 6.Rheumatology and RehabilitationSchool of Medicine Tanta UniversityTantaEgypt
  7. 7.AnatomyTaibah UniversityTaibahSaudi Arabia

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