A Nationwide Survey on Patient’s versus Physician´s Evaluation of Biological Therapy in Rheumatoid Arthritis in Relation to Disease Activity and Route of Administration: The Be-Raise Study

Abstract

ObjectivesBiological treatment of rheumatoid arthritis (RA) is one of the cornerstones of current treatment strategies for the disease. Surprisingly little information exists on whether the route of administration affects patients’ treatment satisfaction. It is equally unclear whether rheumatologists are able to accurately perceive their patients’ appreciation. Thus, the Belgian Be-raise survey aimed to examine whether RA patient’s experience of their current biological treatment coincided with the treating physician’s perception.MethodsA nationwide cross-sectional survey was conducted by 67 Belgian rheumatologists providing data obtained from 550 RA patients. Patients under stable dose of biologics for at least 6 months, were enrolled consecutively and all completed questionnaires. Separate questionnaires were completed by the treating rheumatologist which evaluated their patient’s perception of the route of treatment administration. This study therefore evaluates whether a treating physician perceives the satisfaction with the route of administration to the same degree as the patient.ResultsCompleted questionnaires were obtained from 293 and 257 patients who obtained treatment via the intravenous (IV) or subcutaneous (SC) route of administration, respectively. 58.4% of patients were in DAS28-CRP(3) remission. Patient satisfaction with disease control was higher (44% scored ≥ 9) than that of the treating physician (35%), regardless of the route of administration (p< 0.01). No differences were seen for the patients treated with an IV as opposed to a SC route of administration. The physician´s perception of patient’s satisfaction with disease control was markedly lower for IV treated patients as opposed to SC treated patients (p< 0.001).ConclusionsPatients’ satisfaction with biological treatment is high, but there is a considerable mismatch between patients´ and rheumatologists´ appreciation on the route of administration of biological therapy in RA. Physicians consistently consider IV biological therapy to be less satisfactory. Patient´s appreciation is largely dependent on disease control, irrespective of the route of administration. Therefore, and encouraging shared decision making, we suggest that physicians and patients discuss the route of administration of biologicals in an open way.

Patient Perspectives on Intravenous Biologics for Rheumatologic Disease

“…Results from the previous literature on patient and physician preferences for biologic therapy suggest a disconnect in patient and physician perceptions . Results of the 2 surveys reported here, along with the results of previous patient preference studies may address this disconnect by providing physicians with information regarding patients’ attitudes and concerns around different rheumatology treatments. This understanding of the patient perspective may help guide physicians’ discussions with their patients about different biologic therapy options.…”

“…As previously noted, there is often a disconnect between patient and physician perceptions of IV therapy, with physicians presenting a more negative perception of IV therapy than that of patients who have been receiving IV therapy . Bridging this gap in patient and provider communication to ensure that the benefits, as well as risks, of both IV and SC options are presented to patients, to allow for a more balanced decision‐making process, could assist with improving biologic treatment adherence and outcomes.…”

What Matters Most to Patients and Rheumatologists? A Discrete Choice Experiment in Rheumatoid Arthritis

“…Patients and physicians have different perceptions and beliefs about health and illness [8][9][10][11]. Adequate understanding of patients' health perceptions and risk tolerance may assist physicians in the decision-making process at the time of the clinical encounters by helping them take into account benefit-risk ratios that are important to patients [11].…”

“…Since patients are more likely to be satisfied and adhere to a treatment that is in line with their preferences [5,6], 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 [7]. 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 [8][9][10][11]. Values assigned by patients to their health status may be strongly driven not only by clinical aspects such as functional status or symptoms, but also by their beliefs and expectations.…”

Shared decision making in routine clinical care of patients with rheumatoid arthritis: an assessment of audio-recorded consultations

“…Matching treatment to patient preferences has been shown to improve adherence 5 6. Previous studies have shown that patient preferences for RA treatment vary widely and often differ from those of clinicians 7–11. Therefore, it is important that clinicians and patients make treatment decisions together using the best available evidence and accounting for patient preferences 12.…”