Patient Decision Aids – Using them to Optimize Early Treatment in Those With Rheumatoid Arthritis

Scientific Study Title: 

Optimizing Early Treatment Strategies in Early Rheumatoid Arthritis through Shared Decision-Making

Study Start Date:

September 2019

End Date:

August 2021

Why Did We Do This Research?

Initially, when patients receive a diagnosis of a chronic disease, such as rheumatoid arthritis, they may feel overwhelmed and find it difficult to make decisions about treatment at the first rheumatology appointment. Patient decision aids are standardized tools that can help patients and their doctors discuss treatment options, leading to shared decision making. Many studies over the last 20 years have highlighted the benefits of decision aids in healthcare. We didn’t always have a good understanding of the best way to use these tools in clinic appointments. In this study, we used a decision aid that we have already developed and tested to help patients newly diagnosed with rheumatoid arthritis make decisions about their treatment. Our focus was to understand the best way to use this tool in the clinic.

What Did We Do?

This research included 2 phases:
Phase 1 included interviews with Canadian healthcare providers and patients with rheumatoid arthritis. We wanted to get their views on patient decision aids and explore the challenges and supports of using them.

Phase 2 included using a behaviour change model called the COM-B (Capability, Opportunity, Motivation, and Behavior) framework to help understand why people do or don’t use decision aids. Mapping of the themes onto the COM-B framework was reviewed by patient partners and researchers and was also used to guide suggestions for how to encourage the use of decision aids on a national scale.

What Did We Find?

Fifteen health care providers and fifteen patients took part in the interviews. From their responses, five key themes were identified:

1. Decision making: Many health care providers tend to make decisions for rheumatoid arthritis patients without involving them much.
2. Patient needs: Patients want emotional support and educational tools to help them take part in making decisions about their treatment.
3. Implementation feasibility: There are many practical challenges to using decision aids in current arthritis-related healthcare systems.
4. Flexibility: Being flexible in how decision aids are implemented is important for success.
5. Health care provider training: Many health care providers are not very interested in getting more training on using decision aids.

Once the themes were mapped onto the COM-B framework, six recommendations were identified by the researchers and patient partners to increase the use of decision aids:

1. Make decision aids easily accessible to patients and provide education on shared decision-making via websites, social media, etc.
2. Develop an education curriculum for rheumatologists on shared decision making.
3. Use decision coaches or patient partners to support patients.
4. Connect decision aids with up-to-date rheumatoid arthritis guidelines.
5. Include shared decision making through the use of decision aids as a normalized standard of care.
6. Conduct trials to see how using decision aids and shared decision-making affects patients.

This research revealed the challenges and helped to identify proposed steps for implementing decision aid use in rheumatoid arthritis care in Canada.

The Research Team

Co-Principal Investigators:

Claire Barber, MD, PhD, FRCPC, Research Scientist, Rheumatology, Arthritis Research Canada (University of Calgary)

Glen Hazlewood, MD, PhD, FRCPC, Research Scientist, Rheumatology, Arthritis Research Canada (University of Calgary)

Co-Investigators:

Nick Bansback, MSc, PhD, Research Scientist, Health Economics, Arthritis Research Canada (University of British Columbia)

Linda Li, BSc(PT), MSc, PhD, FCAHS, Senior Scientist, Arthritis Research Canada (University of British Columbia)

Dianne Mosher, MD, FRCPC (University of Calgary)

Collaborators:

Laurie Proulx, BComm, Vice President, Canadian Arthritis Patient Alliance

Dawn Richards, PhD, Vice President, Canadian Arthritis Patient Alliance

Research Staff:

Victoria Bohm, MSc, MPH (University of Calgary)

Who Funded This Research?

Canadian Initiative for Outcomes in Rheumatology cAre (CIORA)

Related Publications:

• Barber CEH, Spencer N, Bansback N, Zimmermann GL, Li LC, Richards DP, Proulx L, Mosher DP, Hazlewood GS. Development of an Implementation Strategy for Patient Decision Aids in Rheumatoid Arthritis Through Application of the Behavior Change Wheel. ACR Open Rheumatol. 2021 May;3(5):312-323. doi: 10.1002/acr2.11250. Epub 2021 Apr 1. PMID: 33793083; PMCID: PMC8126755.