Background/Purpose: There has been increasing focus on the importance of patients participating in the treatment decision-making process with their physicians.  Previous research has demonstrated that effective physician-patient communication, a key component of shared decision-making, has a positive impact on patient satisfaction and adherence to therapy.¹ The purpose of the study is to understand the patient role in decisions about mode of administration when initiating biologic therapy.  

Methods: In November 2011 through March 2012, semi-structured telephone interviews were conducted with 405 patients diagnosed with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, currently using biologic therapy administered through subcutaneous injection (SQ), and residing in the United States. In August through September 2010, a similar study was conducted among a broader group of immunology patients currently using biologic therapy administered through intravenous infusion (IV), of which 209 were diagnosed with a rheumatology condition. The purpose of both studies was to better understand the patient experience with biologic therapies.

Results: Among rheumatology patients currently using SQ biologic therapy, only 45.2% were offered an IV option prior to initiating SQ therapy.  However, most SQ patients reported that they themselves made the decision to use a SQ therapy either independently (24.6%) or in partnership with their physician (56.8%).  Only 15.3% of patients reported that their physician made the decision independently.  Among rheumatology patients currently using IV biologic therapy, slightly more than half (54.1%) were also offered a SQ option prior to initiating IV therapy.  As was the case with current SQ users, most current IV users reported that they themselves most greatly influenced the decision to use an IV therapy either independently (15.0%) or in partnership with their physician (44.2%), while 32.7% of patients reported that their physician most greatly influenced the decision.

Conclusion: While many patients report being active decision makers, most often in partnership with their physician, patient decisions are quite frequently based on only a subset of the available biologic options. For patients to be active participants in the shared-decision making process, they need to understand both SQ and IV options.  Rheumatologist offices are well positioned to ensure that patients are provided the information and options needed to fully engage in the shared decision-making process.

¹Elwyn G, et al. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 1999;49:477-82.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/shared-decision-making-in-the-choice-of-biologic-medication-the-patient-perspective/