Patient Decision Aid (PDA) for Patients with Rheumatoid Arthritis Reduces Decisional Conflict and Improves Readiness for Treatment Decision Making

Abstract

Objectives The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alphatesting revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients' decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p < 0.001] and prepared the patient for decision making [PDMS: 67.5 (21.0)]. Conclusions We developed a PDA for Spanish patients with moderate-to-severe RA that reduces patients' decisional conflict and increases their readiness for decision making. The use of this PDA in routine clinical practice may improve the quality of the decision-making process and the quality of the choices made.

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

“…Although most of them are involved in the decision-making process, nearly 30% maintain a passive attitude, with the rheumatologist being the one who makes the decision for them. The use of patient decision aids (PDA) in RA may help rheumatologists to involve patients in decision-making by providing detailed information related to the disease and its treatment options and guiding patients through this process [50]. Since PDA provide detailed information about the therapeutic options, its use in clinical practice would cover the demand for more information on therapeutic options found in the study.…”

What Matters to Patients with Rheumatoid Arthritis When Facing Medical or Non-Medical Treatment Decisions?

“…Nevertheless, in the clinical encounter, it is crucial that discussions with patients include an assessment of which treatments are most likely to support their needs, goals, and preferences, and that information that could affect their treatment decision-making be provided as transparently as possible. 1 As the values of patients are highly individualised, subjective and changeable over time, patients should continuously be asked to express their personal values for a specific treatment decision and treatment option. 1 , 22 To assist patients and HCPs with value clarification in daily practice of rheumatoid arthritis care, a generic decision aid on value clarification for a diversity of health treatment decisions might be beneficial.…”

“… 1 As the values of patients are highly individualised, subjective and changeable over time, patients should continuously be asked to express their personal values for a specific treatment decision and treatment option. 1 , 22 To assist patients and HCPs with value clarification in daily practice of rheumatoid arthritis care, a generic decision aid on value clarification for a diversity of health treatment decisions might be beneficial. 15 No such a value clarification tool for rheumatoid arthritis care exists currently in the Netherlands or internationally.…”

“…Furthermore, no pregnant women were involved in our study, and no values on pregnancy or the desire to become pregnant and the use of rheumatoid arthritis drug were formulated, although other studies have shown its relevance. 1 Additionally, the majority of our population had been diagnosed with rheumatoid arthritis for several years and only a few young adults participated in it. This may have had an impact on values about treatment options.…”

“…This is due inter alia to the high number of pharmacological and non-pharmacological treatment options, the lack of clear recommendations for specific treatments, the chronic character of the disease demanding long-term care, and multi-morbidity requiring care and coordination of care by several HCPs. 1 In recent years, shared decision making between HCPs and patients when facing a health treatment decision has gained ground in rheumatoid arthritis care. In shared decision-making, HCPs and patients share the best available evidence when faced with the task of making health treatment decisions – the “team talk”.…”