Suz Jack Chan1, Hui Yee Yeo2, Lisa K Stamp3, Gareth J Treharne4, Carlo A Marra5. 1. School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. 2. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3. Department of Medicine, University of Otago, Christchurch, New Zealand. 4. Department of Psychology, University of Otago, Dunedin, New Zealand. 5. School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. carlo.marra@otago.ac.nz.
Abstract
OBJECTIVES: Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients' preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs. METHODS: A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients' preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment. RESULTS: Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients' perceptions of switching to other DMARDs, 18 studies reported RA patients' preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients' preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients' beliefs, (iii) information needs, and (iv) patient-clinician relationships. CONCLUSION: Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients' decision-making processes.
OBJECTIVES: Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients' preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs. METHODS: A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients' preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment. RESULTS: Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients' perceptions of switching to other DMARDs, 18 studies reported RA patients' preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients' preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients' beliefs, (iii) information needs, and (iv) patient-clinician relationships. CONCLUSION: Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients' decision-making processes.
Authors: Marloes Vermeer; Hillechiena H Kuper; Monique Hoekstra; Cees J Haagsma; Marcel D Posthumus; Herman L M Brus; Piet L C M van Riel; Mart A F J van de Laar Journal: Arthritis Rheum Date: 2011-10
Authors: Georg Schett; Paul Emery; Yoshiya Tanaka; Gerd Burmester; David S Pisetsky; Esperanza Naredo; Bruno Fautrel; Ronald van Vollenhoven Journal: Ann Rheum Dis Date: 2016-06-03 Impact factor: 19.103
Authors: Sophie De Mits; Jan Lenaerts; Bert Vander Cruyssen; Herman Mielants; René Westhovens; Patrick Durez; Dirk Elewaut Journal: PLoS One Date: 2016-11-28 Impact factor: 3.240