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

Mathijssen, Elke; Vriezekolk, Johanna E; Popa, Călin; Bemt, Bart J F van den

doi:10.1136/annrheumdis-2019-216137

Cited by 34 publications

(28 citation statements)

References 47 publications

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“…In addition to the potential time saved by using ePROs, the concept of SDM is an important aspect that could be achieved by continuous patient monitoring and transparent integration of the process into therapy management decisions. A recent study analyzing SDM in RA patients showed that there is still room for improvement [ 32 ]. Interestingly, PROs such as pain, morning stiffness, and patient global assessment were much more often compiled than others, such as SF-36, FACIT-F, or computerized adaptive testing.…”

Section: Discussionmentioning

confidence: 99%

Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study

Krusche¹,

Klemm²,

Grahammer³

et al. 2020

JMIR Mhealth Uhealth

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Background The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.

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Section: Discussionmentioning

confidence: 99%

Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study

Krusche¹,

Klemm²,

Grahammer³

et al. 2020

JMIR Mhealth Uhealth

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“…However, SDM is applied in clinical practice only to a limited extent 8 9. Its low uptake may be attributed to a range of factors affecting successful implementation (eg, a lack of awareness, time constraints and the power imbalance in the healthcare professional–patient relationship) 10 11.…”

Section: Introductionmentioning

confidence: 99%

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

et al. 2020

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ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.

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“…11 In this study 88% of rheumatologists stated that in daily practice they always or very often involved the patient in setting the RA treatment target and the strat- Academic /university 19 (26) Rheumatology nurse in clinic, n (%) 24 (33) shared decision making can be discordant between patient and clinician and in RA a low to moderate level of shared decision making has been identified. 31 This study indicated the need for patient awareness/education of RA-T2T and additionally for the timely use of a disease activity score within the clinical consult. Therefore a KT-tool was developed to address these issues while also prompting a shared decision.…”

Section: Discussionmentioning

confidence: 84%

“…In contrast only 9% of patients were aware of RA‐T2T. Research suggests that the perception of and actual shared decision making can be discordant between patient and clinician and in RA a low to moderate level of shared decision making has been identified 31 …”

Section: Discussionmentioning

confidence: 99%

A patient‐centered knowledge translation tool for treat‐to‐target strategy in rheumatoid arthritis: Patient and rheumatologist perspectives

et al. 2021

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Aim Implementation of treat‐to‐target (T2T) for rheumatoid arthritis (RA) presents many challenges and an evidence‐practice gap has emerged. This study assessed clinician and patient barriers to the implementation of an RA‐T2T strategy and developed a knowledge translation (KT) tool for use in “real‐life” clinical settings. Methods Surveys of patients and rheumatologists measured agreement with RA‐T2T recommendations and use in daily practice. Patient knowledge and perceptions were assessed as was clinician willingness to alter practice and barriers to RA‐T2T using visual analog scales. An electronic KT‐tool was developed and a two‐phase usability trial undertaken to assess use in clinical interactions. Results Ninety‐one percent of patients had no prior knowledge of RA‐T2T but agreed with the recommendations showing mean level agreement scores (8.39‐9.54, SD 2.37‐1.54). Ninety percent were willing to try RA‐T2T, 49% felt their treatment could be improved and 28% wanted more involvement in treatment decisions. Rheumatologists agreed with RA‐T2T recommendations (7.30‐9.27, SD 2.59‐0.91). Barriers to implementation identified by rheumatologists included time, appointment availability and perceived patient reluctance to escalate medications. Usability experiences with the KT‐tool were tracked and clinicians reported it was easy to use (100%), resulted in a discussion of RA‐T2T (73%) and a target being set for 63% of consults. Patients reported they read (92%) and understood (87%) the information in the KT‐tool, and that a target was set in 62% of interactions. Conclusions RA‐T2T uptake in clinical practice may be improved through understanding local clinician and patient barriers and an implementation strategy utilizing a patient‐driven KT‐tool.

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

Cited by 34 publications

References 47 publications

Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study

Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study

Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

A patient‐centered knowledge translation tool for treat‐to‐target strategy in rheumatoid arthritis: Patient and rheumatologist perspectives

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