title: Evaluation of a patient decision aid for initiating disease modifying anti-rheumatic drugs.
abstract: According to international guidelines, treatment of inflammatory arthritis should be based on a shared decision between patient and rheumatologist. Furthermore, patients with inflammatory arthritis have high need of information and want to be more actively involved in medical decision-making. To facilitate shared decision-making and support patients in choosing between disease modifying anti-rheumatic drugs (DMARDs), a web-based patient decision aid (PtDA) was developed. This study evaluated use, appreciation and effect of this PtDA.
  
  
  
  A post-test only study with a historical comparison group was conducted. In a two-year period, all patients diagnosed with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, who were deciding whether to start a (different) DMARD were invited to participate. In the first year, patients received standard information (comparison group). In the second year, patients were referred to the PtDA (intervention group). In both groups, a questionnaire was sent four weeks after consulting the rheumatologist. Patient characteristics included sociodemographic, health-related and preference-related variables. Process measures were for use and appraisal of the PtDA (intervention group only). The primary outcome measure was patients' perceived role in medical decision-making. Secondary outcome measures comprised satisfaction with the decision-making process and the decision, beliefs about medication, adherence to medication and trust in the physician.
  
  
  
  We received 158/232 questionnaires (68 %) from the comparison group and 123/200 (61 %) from the intervention group. The PtDA was used by 69/123 patients (57 %) in the intervention group. Patients who used the PtDA highly appreciated it and perceived it as easy to use and helpful. Relative to the comparison group, patients in the intervention group perceived a more active role in medical decision-making and decisions were more in line with patients' personal preferences. Other outcomes showed no significant difference between the two groups.
  
  
  
  The web-based PtDA was highly appreciated and perceived as helpful for decision-making. Implementation of the PtDA in rheumatology practice was associated with a significantly larger proportion of patients perceiving an active role in medical decision-making and decisions were more in line with patients' personal preferences. The PtDA can be a valuable aid in improving patient participation in decision-making about DMARDs.
authors: Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands. i.nota@utwente.nl.
authors: Ingrid
authors: 0000-0002-4106-1286
authors: I
authors: Nota
authors: Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.
authors: Constance H C
authors: CH
authors: Drossaert
authors: Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.
authors: Erik
authors: E
authors: Taal
authors: Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.|Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands.
authors: Harald E
authors: HE
authors: Vonkeman
authors: Department of Rheumatology, Ziekenhuisgroep Twente, PO Box 7600, 7600, SZ, Almelo, The Netherlands.
authors: Cees J
authors: CJ
authors: Haagsma
authors: Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.|Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands.
authors: Mart A F J
authors: MA
authors: van de Laar
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D012216:Rheumatic Diseases / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents
keywords: DMARDs; Inflammatory arthritis; Patient decision aid; Patient participation; Shared decision-making