Most Patients With Rheumatoid Arthritis Do Not Discuss Treatment With Their Rheumatologist

A majority of people with rheumatoid arthritis (RA) reported having no discussion of treatment goals with their providers, even as the same research linked those discussions to better disease activity (DA) and patient satisfaction.

The report, published in ACR Open Rheumatology, sought to better understand the impact of shared decision-making on treat-to-target goals (T2T) and how treatment discussions affected RA care.

A total of 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female) with a self-reported RA diagnosis answered questions on topics including socio-demographics, DA, diagnosis, treatments, outcomes, and goals.

Most respondents (571; 63%) did not discuss RA treatment goals with providers, even as those who did engage in such discussions were three times as likely to be satisfied with their treatment plans. Patients who discussed treatment goals with their providers were more likely to report lower DA levels and were 68% more likely to achieve remission.

The research was led by the Rheumatoid Patient Foundation, a nonprofit patient advocacy organization based in Florida. The researchers did not respond to requests for comment. The following excerpts have been culled from their study.

What was the principal aim of this study?

Both the usefulness of T2T in RA outcomes and the value of shared decision-making are well established. However, several reports have indicated low levels of T2T implementation in rheumatology practices.

With those reports in mind, this study atttempted to identify whether people with RA discuss treatment goals with their providers, as well as the extent to which such discussions affected treatment outcomes or satisfaction with rheumatology care.

What were the key findings?

The higher the level of DA improvement, the more likely patients were to have discussed treatment goals with their care providers.

Similarly, a respondent’s satisfaction was more affected by whether treatment goals had been discussed with their rheumatology providers than their DA level.

Most patients surveyed expressed satisfaction with their rheumatology care. A total of 83% of those who reported disease remission or mild DA also reported being satisfied or very satisfied with their care, while 72% and 53% of those reporting moderate or severe DA, respectively, also reported being satisfied or very satisfied.

Also in the study, 57% of those who had no treatment plan at all (n=35) reported DA improvement of 20% or less, whereas only 32% of all survey respondents reported DA improvement levels that low.

What is the take-home message for clinicians?

According to the authors, the study demonstrated that shared decision-making and T2T are fundamentally connected. Simply put, patient partnership in treatment decisions appeared to drive T2T success.

What are some potential steps from a research perspective?

The data established a need for further investigation of the relationship between shared treatment goal discussions and DA improvement in RA.

There also is a need, the authors argued, for recommendations and evidence on how T2T and shared decision-making should be implemented and integrated. Future studies should identify aspects of shared treatment goal discussions that are most practical for clinical care.

Read the study here.