Understanding Autonomy in Patients with Moderate to Severe Asthma

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 health care delivery when caring for diverse populations.

Objective: To identify patient characteristics that influence autonomy.

Methods: A total of 295 adults with moderate to severe asthma completed 2 surveys at the beginning of a 1-year randomized clinical trial. The Navigating Ability 2 and Inhaled Corticosteroids Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 10 to 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 = .01), patients with diabetes (P = .01), and those with depressive symptoms (P = .03) at -11.4 (95% CI, -20.5 to -2.3), -4.8 (95% CI, -8.3 to -1.3), and -3.1 (95% CI, -5.9 to -0.3) points, respectively. Non-Hispanic White participants on average were found to have 8.2 (95% CI, 4.5 to 12.0) points higher autonomy scores compared with non-Hispanic Black participants (Bonferroni-adjusted P < .01). Patients with higher functional health literacy had higher autonomy scores (coefficient = 0.24; 95% CI, 0.1 to 0.4; P < .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.

Trial registration: ClinicalTrials.gov NCT01972308.

Keywords: Asthma; Autonomy; Diverse populations; Health care delivery; Health disparities; Health literacy; Inhaled corticosteroids; Medical ethics; Patient-centered care.

Conflict of interest statement

Conflicts of Interest: A.J. Apter is a consultant for UpToDate. She receives research support from the NHLBI. She is an associate editor for the Journal of Allergy and Clinical Immunology. K.H. Morales owns stock in Altria Group, Inc, British American Tobacco PLC, and Phillip Morris International, Inc. T.M. Buckey has no relevant conflicts of interest.

Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Representation of the model estimated mean autonomy scores and 95% confidence intervals associated with selected patient characteristics. The mean scores were derived from responses to the 21-question autonomy assessment. The scores were derived based on predicted values from the estimated model. All categories included in this Figure had statistically significant differences in baseline autonomy based on patient characteristics.

Figure 2.

Relationship between autonomy scores and number of comorbidities (F-statistic (4, 283)=1.33, p=0.257).