Background/Purpose : Normative economic theory assumes that people making decisions have complete information of the options, rationally weigh the opportunity costs, expected outcomes and optimize their net benefit¹. However, rheumatoid arthritis (RA) patients facing medication decisions during a doctor-patient dialogue often do not have all the information needed to make a rational decision. In addition, patients primed with pharmaceutical industry (pharma) ‘decision guides” may choose to escalate DMARD therapy based on the social influence of testimonials²rather than increased knowledge². In the current study, we evaluate how patient beliefs about antirheumatic medicines influence choice to add or change medications when patients are not primed with pharma decision guides.

Methods: We conducted a prospective observational study of doctor-patient discussions about adding or changing medications in consecutive RA patients attending routine rheumatology clinic visits. All patients completed written surveys immediately after medication discussions as well as a 30-day post-visit telephone survey. We evaluated patient beliefs about the proposed medicines from the perspective of the Integrated Model of Behavioral Prediction which included: expected outcomes, as well as perceived social norms and behavioral control².

Results: Of 580 RA patients seen during the observation period, 104 (17.9%) patients discussed starting a new medication. 91 (87.5%) completed the follow up survey. Demographics: Mean age 55.4 years, RA duration 7.5 years, CDAI 20 (range 0-50). 65.4% of discussions involved escalating DMARD therapy. Baseline patient belief about medication (0-5) were that they would: Improve symptoms 4.14 (sd .92), Slow progression 3.76 (sd 1.20), Cause serious adverse effect (SAE) 2.43 (sd 0.77), Others like me would choose to start the medication (Social Norm) 3.95 (sd 0.97), and Self-efficacy to take medication 4.68 (sd .53). A linear regression model of these 5 predictor variables on intention to take the proposed medication had an R² = .143. Standardized β were significant for ‘Belief would have SAE’ – .245 (P=.01) and ‘self-efficacy’ .222 (P=.02) but not ‘Improve symptoms’, ‘Slow progression’ or ‘Social Norm’. 30 days after the doctor-patient dialogue patient beliefs the medication would cause improvement and slow progression increased (P<.01), Self-efficacy to take the medication decreased (P< .01) and beliefs would have SAE and Social Norm were stable (NS).

Conclusion: Patients making real life decisions had high expectations that anti-rheumatics would improve their symptoms, but their preference to initiate therapy was more dependent on the belief they would have a SAE and beliefs of their behavioral control to take the medication. When not primed with pharma materials, patient perception of social norms did not demonstrate a significant effect on preference.

References:

1. Kahneman, D., Tversky, A. (Eds.) (2000) Choices, values and frames. New York: Cambridge University Press.

2. Martin RW et al. Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis. Med Decis Mak 2017;37(5):577-588.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-beliefs-and-preference-to-initiate-a-proposed-medication-in-rheumatoid-arthritis/