Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:While clinician goals when treating rheumatoid arthritis (RA) focus on achieving low disease activity or remission, RA patient goals remain largely unexplored. Patient-clinician goal concordance in other chronic diseases such as diabetes is associated with improved self-management. The aim of this literature review is to identify needs, goals, and expectations of RA patients in order to better guide systematic elicitation of patient goals in clinical encounters.
Methods: An academic librarian searched PubMed, Ovid MEDLINE, PsychINFO, and Cochrane database using a specialized algorithm that incorporated the subject terms: rheumatoid arthritis, goals, health priorities, attitude to health, needs, expectations, activities of daily living, quality of life, and treatment outcome. Search was limited to papers in English and adult patient populations. Titles and abstracts were retrieved and manually screened. The inclusion criteria for the papers were empirical investigations, quantitative or qualitative, involving assessments of the needs, goals, and expectations of adult patients with RA. Investigators then reviewed selected papers utilizing an inductive approach.
Results: Thirty-four articles were identified in the search, of which 21 were included in the final review. We identified 453 discrete patient goals (table) which were grouped into four major themes: 1) the bodily experience of RA, 2) achieving normalcy and wellness maintenance, 3) social connectedness and support, and 4) interpersonal and systemic health care interactions.
Conclusion: RA patients identify many goals not often explicitly considered by clinicians. The four major themes identified in this review will be used to inform a measure designed to capture RA patient goals which reflects that living with RA is a multidimensional experience. RA treatment goals must be collaboratively developed with clinicians and within the context of the patient’s life. Future research should include the measurement of patient goals and the development of a tool designed to elicit patient goals for RA treatment and improve patient-clinician goal concordance. Table – Domain-categorized RA patient goals (n=453)
|The Bodily Experience of Rheumatoid Arthritis||Achieving Normalcy and Wellness Maintenance||Social Connectedness and Support||Interpersonal and Systemic Health Care Interactions|
|Maintain/improve function (30)||Empowerment/Self-efficacy (29)||Social support (12)||Patient-centered care (25)|
|General disease improvement (18)||Normalcy (24)||Social connection (9)||RA patient education improvement (25)|
|Energy improvement (17)||General wellbeing (19)||RA peer support (5)||Access to rheumatology care (17)|
|Pain improvement (17)||Cope with work (17)||Social acceptance/awareness of RA (4)||Sensitive delivery of medical care (17)|
|Stay mobile (16)||Freedom (15)||Access to support services (13)|
|Decrease medication side effects (9)||Cope with domestic pursuits (9)||Physician-patient communication (12)|
|Prevent progression (8)||Mood improvement (11)||Early RA care improvement (8)|
|Swelling improvement (7)||Reduce stress/anxiety (3)||Positive relationship with provider (8)|
|Reduction in medication (6)||Care coordination improvement (7)|
|Stiffness Improvement (6)||Trust in medical provider (5)|
|Improve treatment (5)||Access to primary care (2)|
|Improvement in physical appearance (4)||Cost effective treatment (2)|
|Sexual intimacy/fertility concerns (3)||Equity in RA treatment access (2)|
|Medication effectiveness (3)|
|Fine motor skills improvement (2)|
|General health maintenance (1)|
To cite this abstract in AMA style:Hulen E, Ervin A, Schue A, Evans-Young G, Saha S, Yelin EH, Barton J. Patient Goals in Rheumatoid Arthritis Care: A Literature Review [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/patient-goals-in-rheumatoid-arthritis-care-a-literature-review/. Accessed August 7, 2020.
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