Date: Monday, November 6, 2017
Session Title: Patient Outcomes, Preferences, and Attitudes Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Although patient-reported outcomes (PROs) are routinely collected for research and quality purposes, they have not been routinely incorporated into the routine care of patients. Clinicians are best able to provide chronic disease care that is patient-centered when they have a better understanding of their patients’ lived experiences. We hypothesized that having PRO results describing the range of symptoms and impacts of living with RA during clinic visits would provide insight into patient priorities, values, and preferences and facilitate SDM around treatment choices. Evidence for the impact of PROs on patient management from the clinician’s perspective are presented.
Methods: Participants with RA in an observational study at an academic arthritis center completed PROMIS fatigue, pain, physical function, sleep, and participation on a tablet in the waiting room. Reports of results in numerical and graphical formats were available during the visit for review. Semi-structured interviews were used to query the experiences of rheumatologists and rheumatology fellows on the impact of PROs on RA patient management.
Results: Data are from interviews with 4 rheumatologists and 6 fellow trainees. Among rheumatologists, access to real-time PROMIS results that could be addressed during the visit was highly valued. All stated that completing questionnaires helped patient feel “heard” and discussing results made it clear that patients’ experiences mattered. Several said reports prompted them to ask about symptoms they may have overlooked. There was concern that some symptoms (depression, anxiety) may have little to do with RA; identifying these without a clear pathway to resources was potentially problematic. All noted that how they used results differed depending on the needs of specific patients and the nature of the visit. While rheumatologists felt able to control the time spent discussing results, fellows expressed less certainty about their ability to control conversations, the value of additional PROs for RA care, or its impact on decision-making. Fellows also reported greater discomfort discussing results if they had not yet built a rapport with patients.
Conclusion: Expanded real-time assessments of RA symptom and impacts on day-to-day life as part of routine care appears to offer important new information to make RA care more patient-centered by informing discussions and facilitating shared decision-making around treatment. For trainees, the value of additional symptom information was balanced by concerns about greater time challenges, ways to integrate results into discussions and care plans, and availability of resources to address new problems that were identified. Results highlight opportunities to enhance broader communication skills training around potentially sensitive topics and quality of life in rheumatology training programs.
Funding PCORI IP2-PI0000737 and SC14-1402-10818.
To cite this abstract in AMA style:Bartlett SJ, Clegg Smith K, de Leon E, Jones M, Gutierrez AK, Butanis A, Bingham CO III. Using PROs to Guide Patient-Centered Conversations and Care in Inflammatory Arthritis: The Clinician Perspective [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). http://acrabstracts.org/abstract/using-pros-to-guide-patient-centered-conversations-and-care-in-inflammatory-arthritis-the-clinician-perspective/. Accessed May 23, 2018.
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