Identifying Baseline Differences in Autonomy in Patients with Moderate-Severe Asthma

Rationale: The specialty of Allergy and Immunology is unique in that its providers are tasked with caring for patients of all ages, sexes, and backgrounds. With diverse populations, medical ethics, especially autonomy, play an important role in healthcare delivery. Autonomy is the ability of patients to make informed medical decisions. This ethical value is rooted in disease state understanding. We sought to identify patient characteristics that influence autonomy. Methods: 295 adults with moderate-severe asthma from practices serving low-income neighborhoods completed two surveys at the beginning of a one year randomized clinical trial. The Navigating Ability and ICS Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 18-103. Linear regression was performed on the derived autonomy score predicted by patient baseline characteristics. Results: Comparison revealed lower baseline autonomy in patients reporting Spanish as their primary language (p=0.01) and those with diabetes (p<0.01) or depression (p=0.03) at 11.4, 4.7, and 3.1 points lower respectively. 8.2 points higher autonomy was observed in non-Hispanic whites (p<0.01) and individuals with higher functional health literacy (measured by S-TOFHLA, p<0.01). No other associations were observed. Conclusions: This study demonstrated associations of autonomy with co-morbidities, demographics, and literacy. These results may reflect differences in social, educational, and economic opportunities. Further investigation is needed to assess and understand how socioeconomic and educational factors influence autonomy. By identifying baseline differences in autonomy based on patient characteristics, this project provides an initial step in the process of developing interventions to improve patient autonomy.