Falzer Paul R
VA Connecticut Healthcare System, Clinical Epidemiology Research Center, West Haven, Connecticut, U.S.A.
Pain Pract. 2017 Feb;17(2):214-228. doi: 10.1111/papr.12427. Epub 2016 Feb 23.
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.
达标治疗（T2T）包括一个目标或目的、标准症状评估以及治疗决策。在治疗慢性疼痛的专科领域，预计将协同实施达标治疗。患者充分参与的能力受到了质疑，但这些担忧尚未得到实证验证。本研究探讨了患者自我评估的症状指标和疾病认知如何影响他们改变当前治疗的意愿。
共有157名类风湿性关节炎患者完成了一套标准的“疾病活动度”（DA）测评，包括当前关节疼痛、近期疼痛、日常功能以及总体残疾评估，同时还完成了一份疾病认知问卷和一份改变意愿测评。在6个月的时间里，每隔2个月收集一次数据。使用线性混合模型研究对改变意愿的单一和多重影响。
改变意愿与疾病活动度评分密切且直接相关。作为单一因素具有显著意义的认知，在引入疾病活动度评分后变得不再显著。研究结果在疾病活动度评分与改变意愿之间建立了紧密且一致的联系，并排除了疾病认知介导或调节这种关系的可能性。还发现改变意愿与自我报告的显著症状数量直接相关。
关于患者参与达标治疗协同实施能力的担忧没有得到证实。未来的研究可以探讨目标、评估和治疗决策之间的微妙相互作用，并阐明临床决策实践中存在的未决问题。
