Introduction: Recently, the significance of “shared decision-making” in which patients were actively involved in decision options for treatment on the basis of informed consent, has been recognized. However, few studies concerning this issue have been reported regarding rheumatoid arthritis (RA). We conducted a questionnaire survey on patient involvement in treatment decision-making.
Methods : Five hundred RA patients who attended the May 2009 annual meeting of the RA Patient Association in Japan were enrolled in this study. A questionnaire included disease activity and severity, and preferences regarding the extent of patient involvement in deciding on treatment options. Desired and actual roles were chosen from the following descriptions: #1: I prefer to leave all decisions regarding treatment to my doctor. #2: I prefer my doctor to make the final decision after showing me the best option. #3: I prefer that my doctor makes the final decision after showing me all possible therapeutic options. #4: I prefer that my doctor and I share responsibility for deciding which treatment is best for me. And #5: I prefer that the decision about which treatment I will receive should be made by myself.
Results: The questionnaire was returned by 76.4% of the patients, 91% of whom were women, and 71% were 60 years of age or older. While 54% of the patients selected “#4” as their desired role in the decision-making process, 44% of them indicated that “#3” was their actual role, indicating that they accepted the opinion of the attending physician. The desired role was concordant with the actual role in 45% of the patients, who were more satisfied with their medical care and relied on the physician more than those whose desired and actual roles were in conflict.
Conclusion: The physician should assess individual patient preferences and tailor care accordingly.

Objective : The purpose of this study was to examine the relationships between levels of self-efficacy on health behavior of outpatients with rheumatoid arthritis (RA) and patient's assessment of RA conditions.
Methods : A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 urban hospitals in Japan. The following variables were investigated ; (1) the scale of self-efficacy on health behavior in chronic disease patients (CD-SES), which has 2 subscales : active coping behavior with disease (14 items) and controllability for health (10 items). (2) The demographic data ; age, gender, duration of disease, treatment. (3) patient's assessment of RA conditions : painful joint count, swollen joint count, serum C reactive protein (CRP), patient estimate of global status (PGS) which was measured on a 100-mm visual analogue scale (0=best score), functional disability according to Japanese version of modified Health Assessment Questionnaire.
Results : CD-SES data were obtained from 191 patients. 80% was female with mean age 64.4 yr. Total CD-SES scores significantly correlated with age, PGS and functional disability. The scores of active coping behavior with disease correlated with age, and the scores of controllability for health correlated with PGS. The other variables such as painful joint counts, swollen joint counts, and serum CRP showed no relationship with the scores of self-efficacy.
Conclusion : Self-efficacy on health behavior of RA patients related to PGS and functional disability. The longitudinal study is necessary to ascertain whether the psychological support enhances self-efficacy, and affects clinically important outcome measures such as PGS.

We have used two methods for education of pathology at the Yokohama City University School of Medicine: 1) clinicopathological conferences on autopsy cases and 2) journal club using “Case Records of the Massachusetts General Hospital” published in the New England Journal of Medicine. Both methods are extremely effective for stimulating students' enthusiasm for learning, improving presentation skills, and consolidating the minds of students as future medical staff members. Furthermore, journal club enhances the affinity for reading medical English.