Effects of a Web-Based Patient Decision Aid on Biologics for Rheumatoid Arthritis: A Proof-of-Concept Study

Linda Li¹, Chris Shaw², Diane Lacaille¹, Elaine Yacyshyn³, C. Allyson Jones⁴, Paul Adam⁵, Cheryl Koehn⁶, Alison Hoens⁷, Jasmina Geldman⁸, Charles Goldsmith⁹, Eric C. Sayre⁸ and Nick Bansback¹⁰, ¹Rheumatology, Arthritis Research Canada, Richmond, BC, Canada, ²School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada, ³University of Alberta, Edmonton, AB, Canada, ⁴Physical Therapy, University of Alberta, Edmonton, AB, Canada, ⁵Mary Pack Arthritis Program, Vancouver, BC, Canada, ⁶Arthritis Consumer Experts, Vancouver, BC, Canada, ⁷Dept of Physical Therapy, University of British Columbia, Vancouver, BC, Canada, ⁸Arthritis Research Canada, Richmond, BC, Canada, ⁹Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada, ¹⁰School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Education, patient, patient health, patient preferences, rheumatoid arthritis (RA) and shared dicision making

Session Information

Date: Monday, November 14, 2016

Title: ARHP IV: Clinical Practice, Patient Care and Health Services

Session Type: ARHP Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose : Under the treat-to-target approach for patients with rheumatoid arthritis (RA), a biologic agent is considered when the target is not met despite trying disease-modifying anti-rheumatic drugs. However, patients sometimes struggle with the decision to use these medications due to the potential side effects. We have developed a user-friendly decision aid, ANSWER-2, for patients who are considering biologic and small molecule agents. Patient decision aids are designed to present the potential benefits and harm of treatment options and clarify individuals’ preferences. A main feature of ANSWER-2 is the trade-off exercise designed to help patients consider value-sensitive options (e.g., the mode and frequency of medication administration). We aimed to assess the extent to which ANSWER-2reduces patient’s decisional conflict, and improves their medication-related knowledge and self-management capacity.

Methods: We used a pre-post study design. Participants were recruited from rheumatologists’ clinics, patient groups and social networking sites (e.g., Facebook). Individuals were eligible if they: 1) had a physician diagnosis of RA, 2) had been recommended to start/switch to a new biologic or small molecule agent, and 3) had internet access. Access to ANSWER-2 was provided immediately after enrollment. Participants completed outcome measures before and within 2 days after using ANSWER-2. They included: 1) Decisional Conflict Scale (DCS; 0-100, scores < 25 are associated with follow-through with decisions), 2) Partners in Health Scale (PIHS; 0-88, lower = better), and 3) Medication Education Impact Questionnaire (MeiQ; 6 subscales, higher score = better). Paired t-test or Wilcoxon signed-rank test was used to assess differences pre and post intervention.

Results: 50 participants were enrolled in November 2014 – December 2015. The majority were women (n = 40) with a mean age of 49.6 years (SD: 12.2). 64% (n = 32) attended/completed university. The median disease duration was 5 years (Q1; Q3: 2; 10). The mean DCS was 45.9 (SD: 25.1) pre-intervention and 25.1 (SD: 21.8) post-intervention (change: -21.2, 95% CI: -28.1, -14.4; p < 0.001). Before using ANSWER-2, 20% of participants scored < 25, compared to 52% after the intervention. Similar results were observed in the PIHS (pre: 25.3, SD: 14.8; post: 20.4, SD: 13.0; change: -3.7, 95% CI: -6.3, -1.0; p= 0.009). Findings from the MeiQ were mixed, with statistically significant differences found in the self-management sub-scales (Table 1).

Table 1: Results of MeiQ Subscales
MeiQ subscale (maximum possible score)	Before (SD)	After (SD)	Difference (95% CI)	p
Information Quality (30)	21.9 (5.5)	22.4 (5.0)	0.3 (-0.6, 1.3)	0.490
Active Communication (24)	18.8 (4.6)	19.5 (3.7)	0.7 (-0.1, 1.4)	0.086
Coming to Terms with Diagnosis & Treatment (24)	19.4 (3.0)	19.7 (2.9)	0.3 (-0.3, 1.0)	0.299
Self-management Ability (36)	26.7 (5.3)	28.0 (4.9)	1.3 (0.0, 2.5)	0.048
Self-management Role & Responsibility (36)	31.8 (3.3)	32.6 (2.8)	0.9 (0.2, 1.6)	0.012
Self-management Support (24)	17.5 (4.4)	18.9 (3.2)	1.1 (0.2, 2.0)	0.019

Conclusion: Patients’ decisional conflict and self-management capacity improved after using ANSWER-2. Our results show similar changes to other studies evaluating patient decision aids in chronic diseases, including RA¹. Future research comparing ANSWER-2with education material on biologics will provide further insight into the value of patient decision aids in RA management. (1) Li et al. Arthritis Care Res 66:1472-81, 2014.

Disclosure: L. Li, None; C. Shaw, None; D. Lacaille, None; E. Yacyshyn, None; C. A. Jones, None; P. Adam, None; C. Koehn, None; A. Hoens, None; J. Geldman, None; C. Goldsmith, I have been paid to do statistical consulting on this project, including randomization and overseeing the statistical analysest, 5; E. C. Sayre, None; N. Bansback, None.

To cite this abstract in AMA style:

Li L, Shaw C, Lacaille D, Yacyshyn E, Jones CA, Adam P, Koehn C, Hoens A, Geldman J, Goldsmith C, Sayre EC, Bansback N. Effects of a Web-Based Patient Decision Aid on Biologics for Rheumatoid Arthritis: A Proof-of-Concept Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/effects-of-a-web-based-patient-decision-aid-on-biologics-for-rheumatoid-arthritis-a-proof-of-concept-study/. Accessed .

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