Patient's experiences of the barriers and facilitators to Methotrexate

Abstract

Objective To investigate the barriers and facilitators of adherence to methotrexate (MTX) in people with rheumatic diseases and to explore the experience of shared decision‐making. Methods A qualitative study was carried out. People diagnosed with inflammatory arthritides or systemic autoimmune diseases and who were treated with MTX were invited to participate in focus groups. The discourse was coded and synthesised with a content analysis approach. Results The groups included 12 representative patients (rheumatoid arthritis, spondylarthritis, and systemic lupus erythematosus, taking either oral or subcutaneous MTX). Four main themes were identified: (1) drug‐related aspects (package insert, adverse events, administration, and difficulties with treatment); (2) patient‐physician relationship; (3) social environment (lack of visibility of rheumatic diseases and the support of patient associations); and (4) medication and medical care practicalities (information, reliable sources, and expanding knowledge in other health areas). Conclusions Aspects identified might help improve adherence, including quality information, especially on adverse events, the role of the setting, and shared decision‐making.

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

“…The confidence and ability to use or adhere to parenteral MTX therapy were included in this construct. Ten articles were coded to this construct, 7 quantitative (42,43,46,48,49,52,53), 2 qualitative (54,55), and 1 mixed methods (51). In one study, there was an increase in adherence from 42.0% to 50.7% after switching from oral to subcutaneous MTX (53), and in another study, 89.1% of participants claimed that using MTX injection without assistance instilled a sense of independence (57).…”

“…By spacing the self‐injection of MTX away from daily tasks and activities, participants from one study claimed that they could reduce the impact of MTX injection, especially the general side effects on their daily life (54). Difficulty in removing the MTX injector packaging was identified as a hindrance to adherence and autonomy (55).…”

“…This construct concerns factors that the participant believes will impact their ability to use or adhere to treatment with MTX injections. Thirteen articles were coded to this construct (42–50,52,54–56), 4 of which used qualitative data (51,54–56). The pain associated with MTX injections, which could be a barrier, was mild to almost negligible in one study, as evidenced by a mean pain score of 3.6 on a 100‐mm visual analog scale (0 = no pain and 100 mm = the worst pain imaginable) (45).…”

Towards a consensus for nurse education of methotrexate for people with rheumatic and musculoskeletal diseases: A scoping review

“…Finally, a few studies, namely two qualitative ones (Otón et al., 2022; Sørensen et al., 2020), addressed how the expectations and lay beliefs regarding MTX can affect treatment adherence. These studies provided further insight into the current knowledge that positions these beliefs among major factors influencing adherence in RMD and other chronic diseases (Kvarnström et al., 2021; Pasma et al., 2013; Ritschl et al., 2021) and calls for better communication and a shared decision‐making process (Ritschl et al., 2021).…”

“…Setting realistic but positive expectations about the likely magnitude of benefit, time to the onset of effect and mitigation strategies to limit toxicity and tolerability issues for MTX can favourably influence the drug efficacy through improved compliance. A recent qualitative study, addressing Spanish patients' experiences of the barriers and facilitators to MTX found them to be related not only to (1) drug‐related aspects (package insert, adverse events, administration, and difficulties with treatment) but also to (2) patient‐physician relationship, (3) social environment (lack of visibility of RMDs and the support of patient associations), and (4) medication and medical care practicalities (information, reliable sources, and expanding knowledge in other health areas) (Otón et al., 2022). If there is adequate monitoring and education for these patients and families, it is hoped that these problems will be addressed (Taylor et al., 2019).…”