Treatment goal discussions uncommon and impact outcome in RA
medwireNews: Almost two-thirds of patients with rheumatoid arthritis (RA) say that they have not discussed treatment goals with their healthcare provider, yet those who have such discussions report greater improvements in disease activity, US study data show.
“This study demonstrates that [shared decision-making] and [treat-to-target]—two crucial aspects of current RA treatment guidelines—are fundamentally connected,” write Kelly O’Neill (Rheumatoid Patient Foundation, Lutz, Florida) and co-authors in ACR Open Rheumatology.
Their survey of 907 people with RA (mean duration 11 years) revealed that 63% said they had not been asked what their RA treatment goals were by their healthcare provider.
O’Neill and team observed that participants whose providers discussed goals with them were more likely to report greater levels of disease activity improvement. For example, 46.4% of participants who had discussed their treatment goals reported that their highest level of disease activity improvement was 70% or more, compared with 32.9% of participants who had not discussed their goals.
Conversely, fewer individuals who had versus had not discussed treatment goals reported that their best improvement in symptoms was 20% or lower, at 22.9% versus 36.6%.
And in logistic regression analyses, treatment discussions were associated with a significant 1.8-fold increased likelihood of reaching very high levels of improved disease activity (≥90%).
The proportions reporting treatment satisfaction were 86% in the group that had discussed treatment goals and 63% in the group who had not, corresponding to a significant 3.4-fold increased likelihood for treatment satisfaction in favor of having treatment discussions.
Despite differences in disease outcomes between the two groups, both were largely in favor of using RA goal-setting tools with their provider. Specifically, 80% of the group who had previously had treatment discussions and 78% of the group who had not had such dialogs answered that they would be likely or very likely to use materials that “could help you and your provider work together to set treatment goals.”
O’Neill and team acknowledge that the reliance on patient self-reports and accurate recall may be a limitation of the study, but they point out that “understanding and recalling specific conversations about treatment goal-setting may be an indicator of effective [shared-decision making] and a high level of patient participation.”
They conclude: “Patient partnership in treatment decisions appears to be a key aspect of [treat-to-target] success, demonstrated by the overwhelming relationship between shared treatment goal discussions and patient satisfaction.”
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