Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.
Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Denmark.
Clin Rheumatol. 2022 Mar;41(3):695-704. doi: 10.1007/s10067-021-05961-8. Epub 2021 Oct 15.
Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients' preferences to increase patient-centeredness in treatment decisions. The aim of this study was to identify patient-relevant treatment attributes to consider when individualising treatment for patients with RA.
Patients with RA in Sweden were invited to rank the most important treatment attributes in an online survey (April to May 2020). Semi-structured interviews were conducted (October to November 2020) to further identify and frame potential attributes for shared decision-making. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis. Patient research partners and rheumatologists supported the selection and framing of the treatment attributes across the assessment.
The highest ranked attributes (N = 184) were improved functional capacity, reduced inflammation, reduced pain and fatigue and the risk of getting a severe side effect. The framework analysis revealed two overarching themes for further exploration: treatment goals and side effects. 'Treatment goals' emerged from functional capacity, revealing two dimensions: physical functional capacity and psychosocial functional capacity. 'Side effects' revealed that mild and severe side effects were the most important to discuss in shared decision-making.
Functional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Future research should assess how patients with RA weigh benefits and risks against each other, in order to increase patient-centeredness early on the treatment trajectory.
类风湿关节炎（RA）的个体化治疗需要考虑到个体患者的偏好，以增加治疗决策的以患者为中心。本研究旨在确定在为 RA 患者个体化治疗时需要考虑的患者相关治疗属性。
瑞典的 RA 患者被邀请在在线调查中对最重要的治疗属性进行排名（2020 年 4 月至 5 月）。进行了半结构式访谈（2020 年 10 月至 11 月），以进一步确定和构建用于共同决策的潜在属性。访谈进行了录音、转录和主题框架分析。患者研究伙伴和风湿病学家在整个评估过程中支持治疗属性的选择和框架构建。
排名最高的属性（N=184）是改善功能能力、减轻炎症、减轻疼痛和疲劳以及发生严重副作用的风险。框架分析揭示了两个需要进一步探索的总体主题：治疗目标和副作用。“治疗目标”源于功能能力，揭示了两个维度：身体功能能力和心理社会功能能力。“副作用”表明，轻度和重度副作用是共同决策中最重要的讨论内容。
功能能力（身体和心理社会）和潜在副作用（轻度和重度）是在个体化 RA 治疗时需要考虑的重要治疗属性。未来的研究应评估 RA 患者如何权衡彼此的益处和风险，以在治疗轨迹的早期增加以患者为中心。
