629 - The Impact of Patient/Provider Discordance on Changes on Mood, Behavior, and Health-Related Quality of Life in Adolescents with Systemic Lupus Erythematosus

Poster Number: 629
Publication Number: 629.200

Zanab Mian, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, United States; Terrence A. Calistro, Mercy College, Lagrangeville, NY, United States; Kimberly A. Rapoza, Mercy College, Dobbs Ferry, NY, United States; Shari Salzhauer Berkowitz, Mercy College, Dobbs Ferry, NY, United States; Tamar B. Rubinstein, Albert Einstein College of Medicine, White Plains, NY, United States; Kathleen Kenney-Riley, Mercy College, Port Chester, NY, United States; Joyce Hui-Yuen, Cohen Children's Medical Center, New Hyde Park, NY, United States

Background: Discordance between physicians’ and patients’ perceptions of disease severity can negatively impact treatment and disease outcomes; this has not yet been studied in children and adolescents with systemic lupus erythematosus (SLE). Neuropsychiatric symptoms, including depression and anxiety, can be present in up to 65% of adolescents with SLE.

Objective: We propose to investigate the prevalence of mood and behavioral changes, and its association with discordance between patient and physician perceptions of disease severity.

Design/Methods: This is a multicenter study conducted between September 2019 and November 2021. Patients over 12 years of age fulfilling either ACR or SLICC criteria for SLE were enrolled from two tertiary pediatric rheumatology centers in NY. Data including demographics, disease manifestations, medications, and disease severity were collected. Patients completed standardized surveys assessing depression and various measures of quality of life. Global scores were obtained from individual patients and providers, analyzed via two-tailed t-tests, and compared with survey data using Pearson’s correlations. A p-value of < 0.05 was considered significant.

Results: A total of 79 patients were enrolled, with a mean age of 19 (range 13-22) years and 81% female. Subjects identified as 43% Hispanic, 34% Black, 8% White, and 3% as Alaskan Native/American Indian. Overall mean patient global score was 3.06 (range 0-9) , and physician global was 1.33 (range 0-7). Mean patient/physician discordance was 1.75 (range (-7)-8). Those with positive discordance had higher rates of mood and emotion changes [Kidscreen-52 mood/emotional domains (r=0.26, p< 0.05) and self-perception domains (r=0.28, p< 0.05); PROMIS-25 anxiety domains (r=0.25, p< 0.05) and depression domains (r=0.28, p< 0.05)]. Positive discordance was also associated with higher scores reflecting difficulty with physical function and reported disease activity, as noted on PedsQL physical domain (r=0.35, p< 0.05). This relationship was seen despite providers perception of stable disease. There was no association or significant difference between discordance vs. race, ethnicity, medications, or clinical manifestations of disease.Conclusion(s): We found that pediatric SLE patients who exhibited positive discordance with provider perception reported higher rates of mood, emotional, and physical functional changes as assessed via specific survey domains, despite provider perception of stable disease.