O'Neill Kelly D, Marks Kathryne E, Sinicrope Pamela S, Crowson Cynthia S, Symons Dana, Myasoedova Elena, Davis John M
Rheumatoid Patient Foundation, Lutz, Florida.
Rheumatoid Patient Foundation, Lutz, Florida, and Brigham and Women's Hospital, Boston, Massachusetts.
ACR Open Rheumatol. 2021 Dec;3(12):870-878. doi: 10.1002/acr2.11335. Epub 2021 Sep 18.
Treat-to-target (T2T) and shared decision-making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction.
An anonymous, web-based questionnaire was presented to United States residents aged 18 years or older with a self-reported diagnosis of RA by a medical professional with 28 questions regarding socio-demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ and rank sum tests for comparisons.
The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission.
A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen.
治疗达标（T2T）和共同决策是当前类风湿关节炎（RA）管理指南所重视的特征。尽管T2T已证明对改善RA结局具有价值，但实施情况仍不一致，且缺乏纳入患者意见的标准化和程序。我们试图更好地理解共同决策对T2T的影响，以及患者与医疗服务提供者之间的治疗目标讨论如何影响RA治疗的改善和满意度。
向年龄在18岁及以上、自我报告经医学专业人员诊断为RA的美国居民发放一份基于网络的匿名问卷，其中包含28个关于社会人口统计学、RA疾病活动度（DA）、诊断、治疗、结局和目标的问题。分析包括描述性统计以及用于比较的χ检验和秩和检验。
907人完成了问卷（平均年龄58岁；自诊断以来平均11年；90%为女性）。大多数（571人；63%）未与医疗服务提供者讨论过RA治疗目标。与医疗服务提供者进行治疗目标讨论的患者对其治疗计划满意的可能性高出三倍。与医疗服务提供者讨论治疗目标的患者更有可能改善DA水平，达到缓解的可能性高出68%。
大多数RA患者报告未与医疗服务提供者进行过治疗目标讨论；然而，这些讨论与更大程度的DA改善和治疗满意度相关。进一步的研究应寻求理解共同的治疗目标讨论与成功的RA管理之间的关系，并探索开发实用工具，以便在常规临床实践中作为T2T方案的一部分加以实施。
