Background/Purpose: Treatment guidelines in rheumatoid arthritis (RA) frame provider’s therapeutic goal as disease remission. Although goal concordance between providers and patients has been shown to positively impact outcomes in other chronic diseases, like diabetes, patient-provider goal sharing has not been well-studied in RA.  We performed a literature review and conducted focus groups to identify goals important to RA patients.

Methods: A systematic review using PubMed from 1966 to 2013 included terms for RA and patient goals. The results were used to inform domains discussed in focus groups. We conducted 2 patient focus groups (1 in English, 1 in Spanish), and one with rheumatologists. A professional qualitative researcher conducted the English-language patient and physician groups and trained a bilingual moderator who conducted the Spanish group. We used a two-phase structured process where participants first reflected on personal functional and treatment goals as a way to discuss a wide range of goals. The physician group used a similar process, and included a presentation of goals from patient focus groups. We used Grounded Theory to organize goals thematically and combined patient results with goals identified in the literature review.

Results: 865 papers were identified and after review, 28 articles remained; from these, 110 goals were abstracted. Patient goals from focus groups and literature review fell into one of six categories: symptoms, function/quality of life, treatment, research/policy, social support, and system-level goals. Goals identified by both Spanish and English-speaking patients (Table 1) included symptom goals (less pain), function (ability to open jars), and social support (help family understand severity of disease and what to expect), and treatment (more affordable medications). Areas of difference included goals of improved mood (Spanish), more time with providers (Spanish), more coordination among multiple providers (English), sex and intimacy without shame (English). Providers’ goals included remission, cheap and simple medications, and holistic treatments. Physicians expressed surprise with many of the patient-generated goals, including desire for complementary and alternative medication, and felt overwhelmed and ill-supported to manage mood-related issues.

Conclusion: The elicitation of patient goals and goal setting in RA is an important, understudied area especially among vulnerable populations. More research to study the role of eliciting goals, goal concordance, and its impact on outcomes in diverse populations is needed. Interventions to improve goal concordance may improve self-efficacy, adherence, and outcomes in RA.

Table. Patient-reported goals organized by themes from focus groups in English (n=7, all female) and Spanish (n=4, 3 females, 1 male)