title: Proof-of-concept study of a Web-based methotrexate decision aid for patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To assess the extent to which an online patient decision aid reduced decisional conflict and improved self-management knowledge/skills in patients who were considering methotrexate for rheumatoid arthritis (RA).
  
  
  METHODS
  We used a mixed-methods pre-post study design. Eligible participants had a diagnosis of RA, had been prescribed methotrexate but were unsure about starting it, and had access to the internet. Outcome included the Decisional Conflict Scale, the Methotrexate in RA Knowledge Test, and the Effective Consumer Scale. Paired t-tests were used to assess changes before and after the intervention. Randomly selected participants were interviewed at the end of the study about their experiences with the decision aid.
  
  
  RESULTS
  Of 30 participants, 23 were women. Mean ± SD age was 54.9 ± 14.9 years and the median disease duration was 1 year (interquartile range 0.3-5.0 years). Mean ± SD decisional conflict changed from 49.50 ± 23.17 preintervention to 21.83 ± 24.12 postintervention (change -27.67 [95% confidence interval -39.89, -15.44]; P < 0.001). Knowledge of methotrexate improved (mean ± SD 30.62 ± 9.26 preintervention and 41.67 ± 6.81 postintervention; P < 0.001), but there was no change in effective consumer attributes (mean ± SD 68.24 ± 12.46 preintervention and 72.94 ± 12.74 postintervention; P = 0.15). Three themes emerged from interviews of 11 participants: seeking confirmation of one's own knowledge of methotrexate, amplifying reluctance when they encountered information contradicting their own experiences, and clarifying thoughts about the next step during the process.
  
  
  CONCLUSIONS
  Patients' decisional conflict and knowledge improved after using the patient decision aid. Interview findings further highlighted the power of patients' prior knowledge and experiences with RA on how they approach the information presented in a decision aid.
authors.affiliation: University of British Columbia and Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Li
authors.forename: Paul M
authors.initials: PM
authors.lastname: Adam
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Backman
authors.forename: Sydney
authors.initials: S
authors.lastname: Lineker
authors.forename: C Allyson
authors.initials: CA
authors.lastname: Jones
authors.forename: Diane
authors.initials: D
authors.lastname: Lacaille
authors.forename: Anne F
authors.initials: AF
authors.lastname: Townsend
authors.forename: Elaine
authors.initials: E
authors.lastname: Yacyshyn
authors.forename: Charlene
authors.initials: C
authors.lastname: Yousefi
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Jenny
authors.initials: J
authors.lastname: Leese
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003220:Conflict, Psychological; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate