title: Implementing Treat-to-Target Practices for Chronic Pain Through Shared Decision Making: Requisites, Prospects, and Challenges.
abstract: Treat-to-target (T2T) includes a target or goal, standard symptom assessment, and a treatment decision. In specialties that threat chronic pain, T2T is expected to be implemented collaboratively. The ability of patients to participate fully has been questioned, but these concerns have not been demonstrated empirically. The current study examined how patient self-assessed symptom measures and illness beliefs affect their willingness to change their current treatment.
  
  
  
  A total of 157 patients with rheumatoid arthritis completed a standard "disease activity" (DA) battery consisting of current joint pain, recent pain, daily functioning, and generality disability assessments, along with an illness belief questionnaire and a willingness to change measure. Data were collected at 2-month intervals over a 6-month period. Single and multiple influences on willingness to change were examined using linear mixed models.
  
  
  
  Willingness is strongly and directly associated with DA scores. Beliefs that were significant as single factors became nonsignificant once DA scores were introduced. The findings established a strong and consistent link between DA scores and willingness, and ruled out the prospect that illness beliefs mediate or moderate this relationship. It was also found that willingness to change is directly related to the number of significant self-reported symptoms.
  
  
  
  Concerns about the ability of patients to participate in a collaborative implementation of T2T were not substantiated. Future studies can examine the subtle interplay of goals, assessments, and treatment decisions and clarify outstanding issues about the practice of clinical decision making.
authors.affiliation: VA Connecticut Healthcare System, Clinical Epidemiology Research Center, West Haven, Connecticut, U.S.A.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Falzer
mesh_terms: D000203:Activities of Daily Living; D018771:Arthralgia / Q000209:etiology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000150:complications; D001290:Attitude; D059350:Chronic Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D000066491:Clinical Decision-Making / Q000379:methods*; D003469:Culture; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012647:Self-Assessment; D011795:Surveys and Questionnaires
keywords: chronic pain; patient decision making; practice guidelines; rheumatoid arthritis; shared decision making; treat-to-target