Use of Decision Support for Improved Knowledge, Values Clarification, and Informed Choice in Patients With Rheumatoid Arthritis

Abstract

Background The objective of this study was to examine the potential value of a theory-based, interactive decision support tool in clinical practice for patients with rheumatoid arthritis (RA) who are candidates for biologics. Methods We conducted an 8-week, 2-arm, parallel, single-blind, pilot trial in which candidates for treatment escalation with a biologic were randomized to receive a link to a web-based tool or to usual care. Outcomes included change in objective knowledge, subjective knowledge, value clarification and satisfaction with risk communication as well as the proportion of subjects defined as making an informed choice to escalate care at two weeks. Results 125 subjects were randomized. Significant between-group differences at two weeks favoring the intervention group were seen for changes in objective knowledge, subjective knowledge, and value clarification. No significant between-group differences were found in subjects' satisfaction with risk communication. Among those deciding to escalate care, a greater percentage met criteria for an informed choice at two weeks in the intervention group compared to the control group (32% versus 13%, p= 0.02). Improvements in subjective knowledge and value clarification persisted at eight weeks. There were no between-group differences in objective knowledge at eight weeks. Conclusion In this study, use of a decision support tool at the time of decision making resulted in improved objective and subjective knowledge, as well as value clarity, compared to usual care. Not all improvements were sustained, emphasizing the need to offer educational support should additional escalation of care be required over the course of the illness.

Tapering biologic therapy for people with rheumatoid arthritis in remission: A review of patient perspectives and associated clinical evidence

“…However, the change in objective knowledge was significant only at 2 weeks and did not persist (Fraenkel, Matzko, et al, 2015b).…”

“…A disconnect between patient satisfaction with therapy and physician disease and functional assessments has been observed, indicating that satisfaction with therapy involves much more than just achieving control of disease activity (Fraenkel, Seng, Cunningham, & Mattocks, ; Wolfe & Michaud, ). Concerns about adverse effects for any class of antirheumatic medication, negative impacts of treatments on quality of life, and loss of disease control are all notable concerns for people with RA, and there is a preference for accepting the status quo over changes to treatment that may lead to future improvement in disease control (Fraenkel, Matzko, et al, ; Wolfe & Michaud, ). It remains to be seen whether these broad concerns about tapering generalize to the scenario of tapering biologics or whether non‐adherence and decision‐making processes differ when faced with the option (or requirement) to taper biologics, given the relatively unique pattern of good adherence to these medications that involve patients continuing their biologic in the face of adverse effects (López‐González et al, ; Treharne, Lyons, Hale, Douglas, & Kitas, ; Vogelzang et al, ).…”

“…The results of a randomized controlled trial demonstrated significant improvements after 2 and 8 weeks for changes in perceived knowledge of the risks and benefits of biologics and value clarification in the intervention group compared with those receiving usual care. However, the change in objective knowledge was significant only at 2 weeks and did not persist (Fraenkel, Matzko, et al, ).…”

The Gist of Delay of Gratification: Understanding and Predicting Problem Behaviors

“…These assessments should ideally reflect theoretical mechanisms that are evidence-based. Here, we exploit research on memory representations of core valuescalled gist principles-that have been shown to guide decision making in multiple domains (e.g., Broniatowski, Klein, & Reyna, 2015;Fraenkel et al, 2012Fraenkel et al, , 2015Mills, Reyna, & Estrada, 2008;Reyna & Mills, 2014;Wolfe et al, 2015; for overviews, see Reyna, 2012;Reyna & Brainerd, 2011).…”

“…Thus, consistent with prior gist-principles scales, we constructed a scale of simple values related to delay of gratification (e.g., Broniatowski et al, 2015;Fraenkel et al, 2012Fraenkel et al, , 2015Reyna, 2008;Reyna & Mills, 2014). We used money as a "common currency" to tap reward sensitivity (Levy & Glimcher, 2012), but, as we test in the second and third studies, we expected that these principles apply beyond problems with money to other problem behaviors.…”