Rheumatoid arthritis patient perceptions on the value of predictive testing for treatments: a qualitative study.
Rheumatoid arthritis (RA) is a long term condition that requires early treatment to control symptoms and improve long-term outcomes. Lack of response to RA treatments is not only a waste of healthcare resources, but also causes disability and distress to patients. Identifying biomarkers predictive of treatment response offers an opportunity to improve clinical decisions about which treatment to recommend in patients and could ultimately lead to better patient outcomes. The aim of this study was to explore the understanding of and factors affecting Rheumatoid Arthritis (RA) patients' decisions around predictive treatment testing.



A qualitative study was conducted with a purposive sample of 16 patients with RA from three major UK cities. Four focus groups explored patient perceptions of the use of biomarker tests to predict response to treatments. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis by three researchers.



Data were organised within three interlinking themes: [1] Perceptions of predictive tests and patient preference of tests; [2] Utility of the test to manage expectations; [3] The influence of the disease duration on take up of predictive testing. During consultations for predictive testing, patients felt they would need, first, careful explanations detailing the consequences of untreated RA and delayed treatment response and, second, support to balance the risks of tests, which might be invasive and/or only moderately accurate, with the potential benefits of better management of symptoms.



This study provides important insights into predictive testing. Besides supporting clinical decision making, the development of predictive testing in RA is largely supported by patients. Developing strategies which communicate risk information about predictive testing effectively while reducing the psychological burden associated with this information will be essential to maximise uptake.
School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK. Kanta.kumar@manchester.ac.uk.|Arthritis Research UK Centre for Genetics and Genomics Centre for Musculoskeletal Research, Institution of Inflammation and Repair, University of Manchester, Manchester, M13 9PL, UK. Kanta.kumar@manchester.ac.uk.
Kanta
K
Kumar
Manchester Centre for Health Psychology, School of Health Sciences, Manchester, M13 9PL, UK.
Sarah
S
Peters
Arthritis Research UK Centre for Genetics and Genomics Centre for Musculoskeletal Research, Institution of Inflammation and Repair, University of Manchester, Manchester, M13 9PL, UK.|NIHR Manchester Musculoskeletal BRU, Central Manchester Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
Anne
A
Barton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy*; D015415:Biomarkers; D000066491:Clinical Decision-Making / Q000379:methods; D032882:Comprehension; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D012017:Referral and Consultation; D016896:Treatment Outcome; D006113:United Kingdom
D015415:Biomarkers
Patient perspective; Predictive testing; Rheumatoid arthritis