Munro Sarah, Spooner Luke, Milbers Katherine, Hudson Marie, Koehn Cheryl, Harrison Mark
1Department of Family Practice, University of British Columbia, Vancouver, BC Canada.
3Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC Canada.
BMC Rheumatol. 2018 Jul 5;2:18. doi: 10.1186/s41927-018-0026-7. eCollection 2018.
There is growing evidence that it may be possible to identify people at high risk of developing rheumatoid arthritis (RA). Assuming that effective interventions were available, this could mean that treatments introduced in the pre-symptomatic phase could prevent or delay the onset of the disease. Our study aimed to identify the potential attributes involved in decision-making around whether or not to take preventive treatment for RA, in order to inform the development of a discrete choice experiment (DCE) to ascertain consumer preferences for a preventive treatment program for RA.
We conducted a focus group study to develop conceptual attributes, refine their meaning, and develop levels. Participants included RA patients, first-degree relatives of RA patients, and rheumatologists who were 18 years of age and over, could read and speak English, and could provide informed consent. Candidate attributes were refined through iterative rounds of data collection and analysis. All focus groups were audio-recorded and transcribed, and then analyzed using the Framework Method to identify, compare, and contrast key conceptual attributes.
Attributes identified from analysis included: and Patients with RA, first-degree relatives of patients, and rheumatologists all valued the accuracy of testing due to concerns about false positives, and valued certainty in estimates of the test and preventive treatment. Patients and first-degree relatives desired this evidence from a range of sources, including discussions with people with the disease and health care professionals, and their preferences were modified by the strength of recommendation from their health care professional.
The role of the person who and the are novel potential attributes involved in decisions around whether or not to take preventive treatment for RA, that have not been included in previous DCEs.
越来越多的证据表明，有可能识别出患类风湿性关节炎（RA）风险较高的人群。假设存在有效的干预措施，这可能意味着在症状出现前阶段引入的治疗可以预防或延缓疾病的发作。我们的研究旨在确定围绕是否采取RA预防性治疗的决策中涉及的潜在属性，以便为开展离散选择实验（DCE）提供信息，以确定消费者对RA预防性治疗方案的偏好。
我们进行了一项焦点小组研究，以确定概念属性、完善其含义并确定层次。参与者包括18岁及以上、能读写英语且能提供知情同意书的RA患者、RA患者的一级亲属以及风湿病学家。通过多轮数据收集和分析对候选属性进行完善。所有焦点小组均进行了录音和转录，然后使用框架法进行分析，以识别、比较和对比关键概念属性。
分析确定的属性包括：RA患者、患者的一级亲属和风湿病学家都因担心假阳性而重视检测的准确性，并且重视检测和预防性治疗估计的确定性。患者和一级亲属希望从包括与患者及医疗保健专业人员讨论在内的一系列来源获得此类证据，并且他们的偏好会因医疗保健专业人员建议的力度而改变。
在围绕是否采取RA预防性治疗的决策中，提供信息者的角色以及建议力度是新的潜在属性，以前的DCE中未包括这些属性。
