“Effective risk communication is an essential component of care for [rheumatoid arthritis] RA patients,” says Liana Fraenkel, MD, MPH, from Yale University School of Medicine, Section of Rheumatology, and colleagues.
The decision to escalate care for patients with RA can be difficult without adequate decision-making support and education, particularly with regard to initiating therapy with a biologic agent. In their most recent research, Dr. Fraenkel and colleagues assessed the value of a previously developed, Web-based interactive decision support tool and its ability to increase a patient’s objective and subjective knowledge, as well as values clarification and satisfaction with communication. The tool, which was developed with extensive patient and physician input, was also evaluated for the number of patients with the ability to make an informed choice to escalate care by going on a biologic agent after two weeks. The results were published in the November 2015 issue of Arthritis Care & Research.
This eight-week, single-blind pilot trial included 125 patients with RA who were randomized into two groups: an intervention group using the online tool and a control group following the standard course of care. The intervention group was given access to the online tool and asked to review its content within two weeks. No limit was placed on how often the information was access. The control group received education and counseling from an experienced nurse, which is the current standard of care.
The Results
“We found that patients viewing an interactive Web-based tool designed to effectively inform patients about the risks and benefits associated with adding a biologic agent in order to control disease activity resulted in significant improvements in objective knowledge, subjective knowledge and values clarity,” write the authors.
No measurable increase in objective or subjective knowledge was demonstrated in the control group. After two weeks, a greater percentage of the intervention group met the criteria for making an informed choice: 32% vs. 13% for the control group. According to the researchers, “This difference remained statistically significant (37% vs. 11%; P=0.001) when all individuals, whether or not they had escalated treatment, were included in the sample. … Among those escalating care, the proportion defined as making an informed choice was significantly greater among those randomized to the intervention than the control arm.”
In this study, 90% of treatment changes resulted in the initiation of a biologic. Because of this high rate, researchers say they were unable to evaluate whether or not decision support changes treatment escalation rates. “Future studies conducted in clinical settings with average to lower than expected escalation rates will help determine whether the benefits of the tool extend beyond improving knowledge and values clarification,” they write.
Going forward, researchers note the importance of adapting the tool for mobile devices to meet the demand “to provide health-related decision support on … readily available platforms.”
Additionally, the researchers conclude, “Future efforts will be required to ensure that the information is updated as needed, and that the tool is easily accessible, ideally via a link through trusted websites already familiar to rheumatologists.”
Fraenkel L, Matzko CK, Webb DE, Oppermann B, Charpentier P, Peters E, Reyna V, Newman ED. Use of decision support improves knowledge, value clarification and informed choice in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2015 Jul 20. doi: 10.1002/acr.22659. [Epub ahead of print]
