Format

Send to

Choose Destination
Arthritis Care Res (Hoboken). 2018 Oct 28. doi: 10.1002/acr.23801. [Epub ahead of print]

A Qualitative Exploration of Triangulated Shared Decision Making in Rheumatoid Arthritis.

Author information

1
Yale University School of Medicine, Internal Medicine (Rheumatology), 333 Cedar Street, New Haven, CT, 60510.

Abstract

OBJECTIVE:

Treat-to-target implementation in rheumatoid arthritis (RA) requires a shared decision making (SDM) process. However, ability to pay is a major determinant of patient choice, but how this factor affects SDM is under explored.

METHODS:

Visits at four RA clinics during which patients faced a decision to change their treatment were audiotaped between May 2016 and June 2017. Audiotapes were transcribed verbatim and analyzed using qualitative Framework Analysis.

RESULTS:

156 visits were analyzed. Most RA patients, except those with effective insurance coverage, had deliberations disrupted or sidelined by third-party insurance providers having power to authorize the preferred DMARD choice. This triangulated SDM complicated efficiency in deliberations and timely treatment, and was a barrier to shared engagement about health risks and symptom improvement typically found in patient-provider dyads.

CONCLUSION:

Rheumatology care providers should aim to incorporate treatment costs and ability to pay into their deliberations so individualized out-of-pocket estimates can be considered during triangulated SDM at point-of-care. This article is protected by copyright. All rights reserved.

PMID:
30369071
DOI:
10.1002/acr.23801

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center