Background/Purpose: Goal concordance between patients with chronic diseases and their clinicians has been linked to improved outcomes, but not explored in rheumatoid arthritis (RA). Our objective was to assess the extent to which RA patient goals for treatment are concordant with their rheumatologists and to identify correlates of goal concordance.

Methods: Patients meeting 2010 ACR criteria for RA and seen at least once in the prior 12 months at one of two rheumatology clinics (Veterans Affairs Hospital-based or university-based) were enrolled in a cross-sectional survey study. Both enrolled RA patients and their corresponding rheumatology fellow or attending who agreed to participate completed the RA goals measure (ranked top three goals for RA treatment out of eight possible choices) prior to the clinic visit. Patients then completed a longer survey on overall health, medications, demographics, health literacy, adherence and function. Primary outcome was goal concordance defined as the patient’s #1 goal being listed among any of the top three listed by the clinician. Differences in baseline patient characteristics by goal concordance were assessed using chi-square or Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: A total of 171 patient-clinician dyads were analyzed. Patients were 50% female, 15% Spanish-speaking, and 25% had limited health literacy. “Have less pain” was selected by both in 82% of dyads and “have fewer problems doing daily activities” by 61% (table). The proportion of dyads in which the clinician ranked the patient’s #1 goal among the top three was 80%. Given the overwhelming agreement around pain, the proportion of dyads with goal concordance after removing pain, fell to 36%. Goal concordance did not vary by age, gender, race/ethnicity, or health literacy. However, Spanish language was associated with a greater proportion being concordant with clinicians.  Of note, 27% of patients ranked “feel less tired” as one of their top three compared to only 6% of clinicians, 12% of patients ranked “improve mood” compared to 0% of clinicians, and 40% of clinicians ranked “Avoid side effects from medicine” compared with 14% of patients.

Conclusion: Among 171 RA patient and clinician dyads, the majority of patients shared their top goal with their clinicians’ top three, with “have less pain” as the most common goal. Beyond that shared goal, clinicians prioritized avoidance of side effects while patients ranked improved sleep, less fatigue, and improved mood. Tools to facilitate goal elicitation may help improve communication of what matters most to RA patients.

Table. Patient and clinician agreement on treatment goals for rheumatoid arthritis

¹ One of three goals selected for both patient and clinician