Background/Purpose: Evidence-based guidelines for rheumatoid arthritis (RA) call for shared decision-making (SMD) as a method to personalize treatment decisions and achieve treat-to-target goals. We assessed alignment and discordances on treatment and SDM perceptions among RA patients and their rheumatology care teams.

Methods: Between 09/2019 and 06/2020, surveys were administered to RA patients and their health care professional (HCP) teams as part of in-clinic collaborative patient education sessions across 13 US-based rheumatology community practices. On 5-point Likert scales and multi-select questions, patients and HPs rated or indicated their perceptions, preferences, and concerns regarding RA treatment and SDM.

Results: Surveys were completed by 137 patients with RA (81% female, mean age 57 years) and 41 HCPs (52% physicians, 20% nurse practitioners, 4% physician assistants, 24% nurses) who reported 13 mean years of experience in rheumatology. Alignments were found in patients’ and HCPs’ perceptions of patients’ current level of RA control (well or very well controlled: 50% patients vs 58% HCPs) and satisfaction with current therapy (high or very high: 68% patients vs 65% HCPs).

Discordances were found in patients’ and HCPs’ top goals for RA treatment (Figure 1), which included: prevent joint damage (46% patients, 28% HCPs), achieve remission (42% patients, 20% HCPs), avoid extra-articular manifestations (33% patients, 16% HCPs), improve ability to perform daily tasks (26% patients, 52% HCPs), and minimize therapy side effects (12% patients, 52% HCPs). Discordances were also observed in patients’ and HCPs’ main concerns about targeted therapy for RA (Figure 2), which included potential side effects (54% patients, 42% HCPs), efficacy (46% patients, 17% HCPs), cost (17% patients, 50% HCPs), and monitoring requirements (6% patients, 33% HCPs).

A high proportion of patients and HCPs reported often or always engaging in multiple components of SDM (Figure 3). However, compared with their patients’ responses, HCPs underestimated how often they: explain goals of treatment (80% patients; 65% HCPs), explain disease severity to patients (74% patients; 60% HCPs), and ask patients’ treatment goals, preferences, and concerns (77% patients; 63% HCPs). When asked about the main barrier to SDM, patients reported not knowing enough about RA and available therapies (46%) while HCPs reported perceived patient resistance to SDM (57%).

Conclusion: Identifying alignments and discordances in perceptions of treatment and SDM can support rheumatology teams in individualizing treatment decisions and patient engagement for optimal RA care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/alignment-and-discordances-in-treatment-perceptions-and-shared-decision-making-among-ra-patients-and-rheumatology-care-teams/