Background/Purpose:

To evaluate the comparative effects of a pharmaceutical industry decision guide (Pharm Booklet) and International Patient Decision Aids Standard (IPDAS) compliant patient decision aids (PtDA) on patient choice to intensify rheumatoid arthritis (RA) therapy.

Methods:

We conducted a mail survey of 797 biologic naïve RA patients in a community rheumatology practice. Patients were presented with a hypothetical decision scenario where they were asked to consider adding Enbrel^TM (etanercept) to their current regimen.  Each was randomized to review 1 of 3 forms of etanercept specific decision support: a long  24 page PtDA (LONG DA), a short 2 page PtDA (SHORT DA), or the manufacture’s Enbrel^™ decision guide (Pharm Booklet). Each subject was evaluated for: their decision to intensify therapy, beliefs about etanercept viewed through the Integrated Model of Behavioral Prediction, pre and post intervention etanercept related knowledge and decisional conflict.

Results:

402 anti-TNF naïve RA patients participated (response rate 52%). 30.6% of patients randomized to Pharm Booklet elected to initiate etanercept. Only 14.6% and 14.0% of patients who reviewed the LONG DA or SHORT DA choose to take etanercept (χ²=15.7; P<.001).   A binary logistic regression model explained 44.2% (R²= .442) of patient choice to intensify therapy by initiating etanercept. The strongest predictor of choice to intensify therapy were beliefs about etanercept: Improve Symptoms (OR = 2.55), Social Normative Beliefs about intensifying therapy with etanercept (OR = 2.24), and likelihood of Adverse Event (AE) (OR= 0.59). LONG and SHORT DA produced greater increase of relevant knowledge, but greater knowledge and feeling of being informed did not impact patient beliefs about etanercept, decisional conflict or their choice to intensify therapy.  After controlling for other co-variates, gender, low income, minority status, HAQ and CDAI did not add to the predictive power of the model.  The brief 2 page PtDA was acceptable to patients, and lead to similar knowledge gains and decisional conflict as a 24 page IPDAS compliant PtDA.

Conclusion:

PHARM Booklet may nudge patients towards adopting a proposed commercial product without critical consideration of the drug attributes.  Patient decision aids offer a balanced alternative that clinicians could use to structure complex medication discussions and support more informed patient choice. We believe patients would benefit if they used them more.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-the-effects-of-a-pharmaceutical-industry-decision-guide-and-decision-aids-on-patient-choice-to-intensify-rheumatoid-arthritis-therapy-with-etanercept/