What Are the Preferences of Patients With Rheumatoid Arthritis for Treatment Modification? A Scoping Review
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SYSTEMATIC REVIEW
What Are the Preferences of Patients With Rheumatoid Arthritis for Treatment Modification? A Scoping Review Suz Jack Chan1 · Hui Yee Yeo2 · Lisa K. Stamp3 · Gareth J. Treharne4 · Carlo A. Marra1 Accepted: 23 November 2020 © Springer Nature Switzerland AG 2020
Abstract Objectives Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients’ preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs. Methods A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients’ preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment. Results Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients’ perceptions of switching to other DMARDs, 18 studies reported RA patients’ preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients’ preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients’ beliefs, (iii) information needs, and (iv) patient–clinician relationships. Conclusion Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients’ decisionmaking processes. Key Points for Decision Makers
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40271-020-00488-7) contains supplementary material, which is available to authorized users. * Carlo A. Marra [email protected] 1
School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
2
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
3
Department of Medicine, University of Otago, Christchurch, New Zealand
4
Department of Psychology, University of Otago, Dunedin, New Zealand
Rheumatoid arthritis patients’ approach to treatment decision making and their perspectives towards diseaserelated outcomes differs to those of clinicians. Decisions that are shared between RA patients and clinicians lead to better disease response and higher patient satisfaction. Patients draw
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