Background/Purpose: Involving patients in treatment decisions is commonplace in healthcare, but patients are frequently accompanied by a support person (companion). Companions are often actively involved in medical consultations, yet their impact on decisions to change medications is unknown. This study aimed to examine the influence of companions on a patient’s decision to transition to a biosimilar.

Methods: Seventy-nine patients with rheumatic diseases taking an originator biologic who regularly attend clinical appointments with a companion were randomized to receive a video explanation alone or with their usual companion. The video explanation included information on the hypothetical transition to a biosimilar and was presented by the same physician to ensure consistency. The information included the manufacturing process, efficacy, safety, and cost benefits of biosimilars. Patients who received the explanation with their companion had some time to discuss the information before making a decision. After receiving the explanation, participants reported their willingness to transition, risk perceptions, difficulty understanding and received social support. Decisional conflict (uncertainty about the decision) and satisfaction with the decision were also measured.

Results: Companions did not influence decisions to transition to biosimilars, with accompanied (n = 21, 53%) and unaccompanied (n = 22, 56%) patients reporting similar willingness to transition (p = 0.73). There was also no significant difference between accompanied and unaccompanied patients’ cognitive risk perceptions (mean (SD) 45.9 (23.4) vs. 43.9 (26.8), p = 0.72) or affective risk perceptions (54.7 (29.3) vs. 46.5 (30.9), p = 0.23). Unaccompanied patients reported finding it easier to understand the explanation compared to accompanied patients (8.2 (1.9) vs. 6.9 (2.4), p = 0.006). Accompanied patients also thought it was more important to receive information with companions than unaccompanied patients (8.3 (2.6) vs. 6.8 (3.2), p = 0.023). Companions did not impact decision satisfaction (p = 0.12) or decisional conflict (p = 0.86). Receiving emotional, but not practical support, was associated with less decisional conflict in accompanied patients (β = -0.63, p = 0.038).

Conclusion: The presence of companions does not influence risk perceptions or decisions about transitioning to biosimilars but may impact patients’ reporting of their ability to understand treatment explanations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-influence-of-companions-on-a-patients-decision-to-transition-to-a-biosimilar-a-randomized-controlled-trial/