The Structure of Motivations Behind Physicians' Treatment Choices for Patients With Rheumatic Diseases: A Bioethical Analysis of a Cross-sectional Study.

Background/objective: The framework for the study centered on the treatment decisions made by physicians during their medical encounters with patients with rheumatic diseases. Our primary objective was to analyze, from a bioethical perspective, the underlying latent factors that influence these treatment decisions, focusing on the physician motivations behind them.

Methods: This cross-sectional study was carried out at an outpatient clinic where 14 certified rheumatologists and 10 trainees worked (February 2023-February 2024). Standardized data from 703 patient-physician encounters regarding the physician's treatment choice, their motivations, and patients' disease activity level were obtained. Exploratory factorial analysis defined how motivations integrate latent factors and structure treatment choices in various health care scenarios, defined by the physician choice and degree and the patient level of disease activity.

Results: The patients were primarily middle-aged women with long-standing rheumatic diseases. Certified rheumatologists and trainees were primarily females. The factorial analysis revealed a 4-factor structure in the majority of the health care scenarios; these latent factors accounted for 54.6% to 65.4% of total variance. The first factor ("Medications shortage and uncertainty") explained the largest percentage of total variance of the treatment choice; this factor violates justice principle. The second factor ("Patient-centered") was associated with motivations related to the patient's sociodemographics, clinical aspects, and preferences, which is related to autonomy principle. The third factor ("Accessibility and affordability") impacts justice principle. The fourth factor ("Evidence-based medicine and experience") was related to beneficence and nonmaleficence principles.

Conclusions: Making treatment decisions is influenced by factors that shape the ethical lattice physicians based their decisions upon.