title: Decision tool to improve the quality of care in rheumatoid arthritis.
abstract: OBJECTIVE
  Despite the importance of achieving tight control, many patients with rheumatoid arthritis (RA) are not effectively treated with disease-modifying antirheumatic drugs. The objective of this study was to develop a decision support tool to inform RA patients with ongoing active disease about the risks and benefits related to biologic therapy.
  
  
  METHODS
  We developed a balanced, web-based, decision support tool. Options, values, and probabilistic information were described using theoretically supported formulations. We conducted a pre-/posttest study to assess preliminary evidence of the tool's efficacy in improving knowledge related to biologics, clarity of values, willingness to take a biologic, and informed choice.
  
  
  RESULTS
  We interviewed 104 subjects (mean age 62 years, 84% women, 87% white, and median duration of RA 8 years). Knowledge (coded on a 0-20 scale) and willingness to take a biologic (coded on a 0-10 scale) significantly increased after viewing the tool (mean differences 2.3 and 1.4, respectively; P < 0.0001 for both). Perceived knowledge and values clarity (coded on 0-100 scales) also significantly improved (mean differences 20.4 and 20.8, respectively; P < 0.0001 for both). The proportion of subjects making an informed value-concordant choice increased substantially from 35% to 64%.
  
  
  CONCLUSIONS
  A tool designed to effectively communicate the risks and benefits associated with biologic therapy increased knowledge, patient willingness to escalate care, and the likelihood of making an informed choice. The results of this study support the need for a clinical trial to examine the impact of the tool in clinical practice.
authors.affiliation: Yale University School of Medicine, Section of Rheumatology, 300 Cedar Street, TAC#525, PO Box 208031, New Haven, CT 06520-8031, USA. liana.fraenkel@yale.edu
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Ellen
authors.initials: E
authors.lastname: Peters
authors.forename: Peter
authors.initials: P
authors.lastname: Charpentier
authors.forename: Blair
authors.initials: B
authors.lastname: Olsen
authors.forename: Lanette
authors.initials: L
authors.lastname: Errante
authors.forename: Robert T
authors.initials: RT
authors.lastname: Schoen
authors.forename: Valerie
authors.initials: V
authors.lastname: Reyna
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002755:Choice Behavior; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents