What Do Rheumatologists and Patients Value Most When Making RA Treatment Decisions?

A new study assessed the preferences of patients and rheumatologists regarding treatment attributes for rheumatoid arthritis (RA) as well as their feelings regarding shared decision-making.

“Since patients are more likely to be satisfied and adhere to a treatment that is in line with their preferences, a patient-centered care approach, defined as ‘providing care that is respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions,’ may have significant impact on treatment outcomes,” the study authors wrote. “In RA, patient and physician assessment of disease severity and treatment response often do not align, suggesting that they focus on different aspects of the disease.”

To conduct their analysis, published in Advances in Therapy, the authors conducted a study based on a discrete choice experiment (DCE).

“In a DCE, individuals are asked to choose their preferred option among different (hypothetical) alternatives. This method is based on two assumptions: (1) that treatments can be described in terms of a set of attributes (characteristics) with varying levels and (2) that the priority given by an individual to treatments depends on the nature and level of the attributes that compose them,” explained the study authors.

Three steps were taken: literature review, RA patient focus group discussion, and rheumatologist focus group discussion. For the literature, a search of Pubmed/Embase up until March 2016 was conducted for relevant studies. The focus groups included five patients and four rheumatologists. Participants reviewed seven attributes with two to four levels in eight scenarios.

Patients, Rheumatologists Hold Some Similar, Different Treatment Values

A total of 90 rheumatologists (mean years of experience, 18.1 years; 52.2% were female; average RA patients per week, 24.4) and 137 RA patients (mean age, 47.5 years; 84.0% were female; mean time since RA diagnosis, 14.2 years; mean time in treatment, 13.2 years) were included in the study.

Attribute utility and relative importance (RI) were measured for rheumatologists (R) and patients (P); outcomes were: time with optimal quality of life (QoL), R=23.41% vs. P=35.05%; substantial symptom improvement, R=13.15% vs. P=3.62%; time to onset of treatment action, R=16.24% vs. P=13.56%; severe adverse events (AEs), R=10.89% vs. P=11.20%; mild AEs, R=4.16% vs. P=0.91%; mode of administration, R=25.23% vs. P=25.00%; and added cost, R=6.93% vs. P=10.66%. Close to three-quarters of RA patients took part in treatment decision-making in some capacity, but more than a quarter played no role in decision-making.

Although the top three attributes were the same between patients and rheumatologists, the order in which they were ranked differed, with patients placing the highest value on time with optimal QoL followed by mode of administration and time to onset of treatment action, compared to rheumatologists, who ranked the top three attributes as mode of administration, time with optimal QoL, and time to onset of treatment action.

“Our results provide knowledge related to patient and rheumatologist preferences for treatment, showing some differences between both perspectives. For rheumatologists, in addition to efficacy, treatment mode of administration and time to onset of action are decision-making drivers. For patients, efficacy defined as time with optimal QoL and treatment mode of administration are determinants in treatment selection,” the study authors summarized.