AB1449-HPR Patient factors contributing to and shared decision making in starting/switching biologics spondyloarthritis

Abstract

BackgroundBiologics are effective for treating symptoms in patients (pts) with active spondyloarthritis (SpA) and a number of drugs are available with different working mechanisms, and mode and interval of administration for this indication. Starting/switching a specific biologic occurs for various reasons. It is increasingly advocated to involve pts in treatment decisions. Pts can have various needs and expectations when involved in shared decision making.ObjectivesTo explore which pts factors contributed to starting or switching biologics in SpA, how pts experienced shared decision making in this process, and the needs of pts starting biologics.MethodsPts with SpA were recruited from the rheumatology department, Maastricht University Medical Centre. In semi-structured focus group interviews pts were asked to elaborate on when and why biologics were started and switched and if they were involved in the treatment decision. A decision aid for rheumatoid arthritis (RA) biologics was shown and pts were asked if they consider a similar decision aid for SpA as valuable. Interviews were audiotaped, transcribed and analysed in NVIVO11 software.ResultsIn total, 14 pts with SpA participated in 4 focus group interviews. Three pts were diagnosed with axial SpA, 5 pts with peripheral SpA and 6 pts were diagnosed with axial- and peripheral SpA, with or without concomitant extra-articular manifestations. Mean age was 62 years (range 41–77 years), 10 were female (62.5%). Average time since diagnoses was 28 years. Pts started on average 7.3 years (range 1–14 years) ago with their first biologic. Six pts used 1 biologic, 5 pts had switched once or twice, and 3 pts switched more than 3 times. Factors contributing to starting a first biologic were disease activity, fatigue, intolerance to prior medication, and ineffectiveness of prior medication. Two pts were included in a biological trial. Factors contributing to switching were adverse effects and ineffectiveness of prior biologic.Most pts were not involved in decision making when biologics were started or could not remember this. Some pts mentioned that only one or limited options were available at the time of start, and that the decision to start was made by the rheumatologist. However, also when more agents became available, decision for a specific biological was often made by the rheumatologist without discussing treatment options.Pts underlined the importance of how care providers offer a treatment decision. When the decision was offered as a suggestion, “Shall we do.”, it was experienced more pleasurable then when the decision was offered as a command, “Let ‘s do.”.All pts expressed their wish to develop a decision aid in which clear information about each biologic is provided on mode of administration, interval, and effect on different SpA features. One pt explicitly stated that he did not want to be actively involved in decision making, but preferred that the care provider decides.ConclusionsWhen involving SpA pts in shared decision making on start/switching of a biological...