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

Hsiao, Betty; Binder-Finnema, Pauline; Nowell, W. Benjamin; Michel, George; Wiedmeyer, Carole; Fraenkel, Liana

doi:10.1002/acr.23684

Cited by 14 publications

(23 citation statements)

References 24 publications

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“…For regulatory decision-making, considering preference heterogeneity in marketing authorisations or in post authorisations may lead to decisions that are more acceptable to the end users. Treatment satisfaction may increase for patients with a higher acceptance of side effects if the prospect of effectiveness is higher [32,33].…”

Section: Discussionmentioning

confidence: 99%

Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

et al. 2020

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Background Preference assessments of patients with rheumatoid arthritis can support clinical therapeutic decisions for including biologic and targeted synthetic medicines to use. This study assesses patient preferences for attributes of second-line therapies and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects. Methods Between November 2018 to August 2019, patients with rheumatoid arthritis were recruited to a survey containing demographic and disease-related questions as well as a discrete choice experiment to measure their preferences for second-line therapies using biologics or Janus kinases inhibitors. Treatment characteristics included were route of administration, frequency of use, probability of mild short-term side effects, probability of side effects changing appearance, probability of psychological side effects, probability of severe side effects and effectiveness of treatment. Results A total of 358 patients were included in the analysis. A latent class analysis revealed three preference patterns: (1) treatment effectiveness as the single most important attribute, (2) route of administration as the most important attribute, closely followed by frequency of use and psychological side effects and (3) severe side effects as the most important attribute followed by psychological side effects. In addition, disease duration and mild side effects influenced the patients’ choices. Conclusion Respondents found either effectiveness, route of administration or severe side effects as the most important attribute. Patients noting effectiveness as most important were more willing than other patients to accept higher risks of side effects.

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Section: Discussionmentioning

confidence: 99%

Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

et al. 2020

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“…Similarly, developing and endorsing rigorous outcomes for trials of PtDAs and other SDM tools is key to their acceptability and uptake. A recent review of PtDAs in RA (35) highlights some of the key challenges and opportunities for research in SDM in our field, including a lack of large‐scale trials, a need to incorporate strategies to share goals (36) and evaluate preference phenotypes (37) for SDM, and a need to develop core outcome domains for trials in SDM (38).…”

Section: Discussionmentioning

confidence: 99%

Development of an Implementation Strategy for Patient Decision Aids in Rheumatoid Arthritis Through Application of the Behavior Change Wheel

Barber

Spencer

Bansback

et al. 2021

ACR Open Rheumatology

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Objective Decision aids are being developed to support guideline‐based rheumatology care in Canada. The study objective was to identify barriers to decision aid use in rheumatoid arthritis (RA) within a behavior change model to inform an implementation strategy. Methods Perspectives from Canadian health care providers (HCPs) and patients living with RA were obtained on an early RA decision aid and on perceived facilitators and barriers to decision aid implementation. Data were collected through semistructured interviews, transcribed, and then analyzed by inductive thematic analysis. The lessons learned were then mapped to the behavior change wheel COM‐B system (C = capability, O = opportunity, and M = motivation interact to influence B = behavior) to inform key elements of a national implementation strategy. Results Fifteen HCPs and fifteen patients participated. The analysis resulted in five lessons learned: 1) paternalistic decision‐making is a dominant practice in early RA, 2) patients need emotional support and access to educational tools to facilitate participation in shared decision‐making (SDM), 3) there are many logistical barriers to decision aid implementation in current care models, 4) flexibility is necessary for successful implementation, and 5) HCPs have limited interest in further training opportunities about decision aids. Implementation recommendations included the following: 1) making the decision aids directly available to patients (O) and providing SDM education (C/M), 2) creating an SDM rheumatology curriculum (C/O/M), 3) using “decision coaches” or patient partners as peer support (C/O/M), 4) linking decision aids to “living” rheumatology guidelines (M), and 5) designing trials of patient decision aid/SDM interventions to evaluate patient‐important outcomes (O/M). Conclusion A multifaceted strategy is suggested to improve uptake of decision aids.

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Section: Discussionmentioning

confidence: 99%

Patient preferences on rheumatoid arthritis second-line treatment: A discrete choice experiment of Swedish patients

Bywall¹,

Kihlbom²,

Hansson³

et al. 2020

Preprint

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Background Preference assessments of patients with rheumatoid arthritis (RA) help inform clinical therapeutic decisions for including biologic and targeted synthetic drugs to use. This study assesses patient preferences for biologics or Janus kinases (JAK) inhibitors and heterogeneity within these preferences to estimate the relative importance of treatment characteristics and to calculate the minimum benefit levels patients require to accept higher levels of side effects. Methods Between November 2018 to August 2019, patients were recruited to participate in a survey containing demographic and disease-related questions as well as a Discrete Choice Experiment to measure their preferences for second-line therapies using biologics or JAK inhibitors. Treatment characteristics (attributes) included in the DCE were mode of administration, frequency of use, probability of mild short-term side effects, probability of side effects affecting appearance, probability of psychological side effects, probability of severe side effects, and effectiveness of treatment. Results A total of 358 patients were included in the analysis. Latent class analysis revealed three preference patterns. When choosing treatment, the respondents found either effectiveness of treatment, mode of administration, or probability of severe side effects as most important. In addition, disease duration and mild side effects influenced the patients’ choices. Conclusion Respondents found either effectiveness, severe side effects, or mode of administration as the most important attribute. Patients noting effectiveness as most important were more willing than other patients to accept higher risks of side effects.

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

Abstract: This study provides an early indication that a value clarification tool allowing patients to consider a set of preference phenotypes can support SDM at the point-of-care without extending visit time. This article is protected by copyright. All rights reserved.

Cited by 14 publications

References 24 publications

Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

Patient preferences on rheumatoid arthritis second-line treatment: a discrete choice experiment of Swedish patients

Development of an Implementation Strategy for Patient Decision Aids in Rheumatoid Arthritis Through Application of the Behavior Change Wheel

Patient preferences on rheumatoid arthritis second-line treatment: A discrete choice experiment of Swedish patients

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