Treat-to-target and shared decision making in rheumatoid arthritis treatment: Is it feasible?

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Clinical Guidelines
Authored By
Falzer PR
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Interests
Rheumatology
Orthopedic
Internal/Family Medicine
Speciality
Orthopedic
Rheumatology
Internal/Family Medicine
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volume
22
ISSN
1756-185X
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ISSN
1756-185X
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true
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Additional Info
["Falzer PR","Publisher: Wiley on behalf of the Asia Pacific League of Associations for Rheumatology Country of Publication: England NLM ID: 101474930 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1756-185X (Electronic) Linking ISSN: 17561841 NLM ISO Abbreviation: Int J Rheum Dis Subsets: MEDLINE","Journal Article","2019-09-01","International journal of rheumatic diseases [Int J Rheum Dis] 2019 Sep; Vol. 22 (9), pp. 1706-1713. Date of Electronic Publication: 2019 Jul 30.","English","1756-185X","Attitude of Health Personnel* , Decision Making, Shared* , Health Knowledge, Attitudes, Practice* , Patient Participation*, Antirheumatic Agents\/*therapeutic use , Arthritis, Rheumatoid\/*drug therapy, Adult ; Aged ; Aged, 80 and over ; Antirheumatic Agents\/adverse effects ; Arthritis, Rheumatoid\/diagnosis ; Clinical Decision-Making ; Cost of Illness ; Disability Evaluation ; Female ; Humans ; Judgment ; Male ; Middle Aged ; Pain Measurement ; Remission Induction ; Severity of Illness Index ; Treatment Outcome ; Young Adult","Adult, Aged, Aged, 80 and over, Antirheumatic Agents adverse effects, Arthritis, Rheumatoid diagnosis, Clinical Decision-Making, Cost of Illness, Disability Evaluation, Female, Humans, Judgment, Male, Middle Aged, Pain Measurement, Remission Induction, Severity of Illness Index, Treatment Outcome, Young Adult, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid drug therapy, Attitude of Health Personnel, Decision Making, Shared, Health Knowledge, Attitudes, Practice, Patient Participation","International journal of rheumatic diseases","22"]
Description
Aim: Current rheumatoid arthritis (RA) guidelines have incorporated a treat-to-target (T2T) approach and require that it be implemented through shared decision making (SDM). Current discourse has questioned whether collaborative T2T is feasible in RA, in part because of discrepancies in the way that patients and practitioners assess progress and decide whether to consider a change in the current treatment. A previous study found that patients' willingness to change is directly associated with their disease activity (DA) scores. The current study continues this line of research by developing and testing a model that describes the role of DA and illness beliefs on RA patients' progress assessments.<br />Method: A questionnaire administered to 156 patients with RA included a self-assessed DA measure (Rapid-4), an illness belief battery (BIPQ), and a progress assessment question. These items populated a descriptive model, based on situation awareness (SA) theory. It posits that progress assessment scores are products of 3 sequential steps: perception, understanding, and forecasting. The first 2 steps were measured by DA scores, the 3rd by illness beliefs. The model was tested using general linear model techniques.<br />Results: All six measures were significantly related to progress assessment scores. The full SA model accounted for over 50% of the variance. The best fitting model included a pain measure at step 1, global disability at step 2, and illness beliefs at step 3.<br />Conclusion: Findings suggest that implementing T2T through SDM is feasible, that there is substantial commonality between how patients and practitioners assess progress, and that discrepancies may be complementary and addressed through interaction. The SA model helps to explain previous findings about the influence of illness beliefs on patients' judgments. It is suggested that future studies acknowledge the feasibility of collaborative T2T and focus attention on how it can work more effectively and comprehensively.<br /> (© Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)
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