Effects of a Web‐Based Patient Decision Aid on Biologic and Small‐Molecule Agents for Rheumatoid Arthritis: Results From a Proof‐of‐Concept Study

Li, Linda; Shaw, Chris; Lacaille, Diane; Yacyshyn, Elaine; Jones, Chelsea; Koehn, Cheryl; Hoens, Alison M.; Geldman, Jasmina; Sayre, Eric C.; Macdonald, Graham; Leese, Jenny; Bansback, Nick

doi:10.1002/acr.23287

Cited by 13 publications

(20 citation statements)

References 30 publications

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“…Our findings are in line with previous studies performed in Canadian and Dutch RA patients [15][16][17]35]. A webbased PDA for initiating DMARDs in Dutch patients with rheumatic diseases [15], including RA, ankylosing spondylitis, and psoriatic arthritis, was perceived as a helpful tool for the decision-making process and increased the number of patients who played an active role in medical decision making [16].…”

Section: Discussionsupporting

confidence: 90%

“…They usually include a specific section that helps patients explore their own perspective and values regarding key aspects of the decision they face [14]. Nowadays, several PDAs for RA patients are available [15][16][17][18][19][20][21][22][23]; however, none of them were developed for the Spanish population and only one was available in Spanish.…”

Section: Introductionmentioning

confidence: 99%

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

Pablos

Jover

Román-Ivorra

et al. 2019

Patient

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Pablos

Jover

Román-Ivorra

et al. 2019

Patient

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“…Martin et al evaluated the effects of different information formats of a decision aid for a hypothetical RA medication and found that experimental design can impact how the effects of a medication are communicated. Li et al evaluated the use of 2 online decision aids for RA patients to be used at home or in clinic: the Animated, Self‐serve, Web‐based Research tool (ANSWER) was designed for RA patients who were unsure about starting methotrexate and ANSWER‐2 was intended for RA patients who received a recommendation to start a biologic or small‐molecule agent or switch to a new one. ANSWER was evaluated using a pre/post study, with results that showed improvement in patients’ decisional conflict and knowledge and ANSWER‐2 was evaluated in a mixed‐methods, pretest/post test study with results showing that patients also had decreased decisional conflict as well as improvement in perceived self‐management capacity, but patient‐physician communication was not measured in either one.…”

Section: Discussionmentioning

confidence: 99%

“…To obtain an objective measure of shared decision‐making, we audiotaped all visits. Thus, we were able to describe in detail how the value clarification tool impacted patient‐provider communication through review of the discussions, compared to patient‐reported outcomes measured in previous studies . In addition, the audiotapes allowed us to time the visits .…”

Section: Discussionmentioning

confidence: 99%

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

Hsiao

Binder-Finnema

Nowell

et al. 2019

Arthritis Care & Research

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“…Two other randomized controlled trials are currently under way to examine the efficacy of PtDAs for people with RA who are starting or switching biologics (http://ClinicalTrials.gov Identifier: NCT02540044 and NCT02787538) (Li et al, ). The use of PtDAs for people with RA who are considering tapering and discontinuing their biologics remains to be explored but has considerable potential as a research method to explore patient perspectives, and as a clinical tool after piloting and detailed evaluation of application in this increasingly pressing scenario.…”

Section: Future Directions For Research On Tapering Biologicsmentioning

confidence: 99%

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

Stamp

Chan

Marra

et al. 2019

Musculoskeletal Care

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Objectives Biologic therapies have increased the control of disease activity in rheumatoid arthritis (RA). Questions remain about tapering biologics when remission is achieved in RA. The patient perspective has to be incorporated in pragmatic applications of tapering but is rarely accounted for in clinical studies of tapering. The aim of the present review was to summarize the evidence about RA patient perspectives on biologic tapering. Methods We provided a narrative summary of the currently small body of research on patient perspectives retrieved through systematic searches with an emphasis on seeking qualitative research. In addition, we provided an update on relevant clinical research and financial considerations that frame the findings on patient perspectives. Results Financial considerations around commencing/continuing on biologic therapies in RA vary internationally and have implications for patient perspectives. Recent clinical studies indicate that the benefit of tapering biologic therapy when in remission are predicted by drug concentration and aspects of disease activity, severity and duration. Three major concerns have been identified from studies of patient perspectives on biologic tapering: (a) disease relapse; (b) access to treatment in the case of disease flare when tapering; and (c) local motivation for dose reduction (i.e., driven by funding or health benefit). Conclusions More research is needed on tapering biologics, and should include studies of patient perspectives as well as health economic evaluations. Patient decision aids are a potential way of applying clinical and patient‐focused evidence to help all parties come to a decision, but require developmental research and pragmatic evaluation.

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Effects of a Web‐Based Patient Decision Aid on Biologic and Small‐Molecule Agents for Rheumatoid Arthritis: Results From a Proof‐of‐Concept Study

Abstract: Patients' decisional conflict decreased and perceived self-management capacity improved after using ANSWER-2. Future research comparing the effectiveness of ANSWER-2 with that of educational material on biologic agents will provide further insight into its value in RA management.

Cited by 13 publications

References 30 publications

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

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

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

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

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