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Arthritis Care Res (Hoboken). 2019 May;71(5):629-637. doi: 10.1002/acr.23684. Epub 2019 Apr 8.

Preference Phenotypes in Support of Shared Decision-Making at Point-of-Care for Patients With Rheumatoid Arthritis: A Proof-of-Concept Study.

Author information

1
Yale University School of Medicine, New Haven, Connecticut.
2
Global Healthy Living Foundation, Upper Nyack, New York.
3
Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut.

Abstract

OBJECTIVE:

In this proof-of-concept study, we sought to evaluate whether a value clarification tool enabling patients to view a set of rheumatoid arthritis (RA) treatment preference phenotypes could be used to support shared decision-making at the point-of-care.

METHODS:

We conducted a pretest/post test study. English-speaking patients with RA presenting to their scheduled outpatient visits were asked to participate. Visits for patients with active RA were transcribed. Shared decision-making components were measured using a quantitative coding scheme based on an established model of shared decision-making.

RESULTS:

Forty-six visits were included in the pretest and 40 in the post test phases. Providers offered more disease-modifying antirheumatic drugs (DMARDs) (2 or more) in the post test visits (60%) compared to the pretest visits (47.8%). Overall, more patients vocalized their values and/or preferences in the post test visits compared to the pretest visits for treatment escalation decisions including a choice of 1 new DMARD (90.9% versus 56.3%), 2 or more new DMARDs (95.8% versus 86.4%), as well as prednisone (87.5% versus 66.7%). Providers were also more likely to base their recommendations on patients' values and/or preferences in the post test (100% of 6 visits) than the pretest (64.3% of 14 visits) phases during visits in which a recommendation was made. The mean ± SD length of the visit was 29.9 ± 11.6 minutes and 25.1 ± 10.7 minutes in the pretest and post test phases, respectively.

CONCLUSION:

This study provides an early indication that a value clarification tool allowing patients to consider a set of preference phenotypes can support shared decision-making at the point-of-care without extending visit time.

PMID:
29953733
PMCID:
PMC6310675
[Available on 2020-05-01]
DOI:
10.1002/acr.23684

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