Rheumatologists value patient-reported RA symptoms over test results
When it comes to informing treatment decisions, rheumatologists value patient-reported symptoms and physical function over physical findings and test results, according to group polling results published in BMC Rheumatology.
“Besides physician-assessed disease activity indices, patient-reported outcomes (PROs) should be incorporated to assess a patient’s health,” Aprajita Jagpal, MD, of the University of Alabama at Birmingham, and colleagues wrote. “It remains unclear which specific instrument would be helpful for the rheumatologist in making therapeutic recommendations for their patients with RA and in providing holistic care.”
“This is despite having multiple options of PROs to choose from such as the Health Assessment Questionnaire (HAQ), Routine Assessment of Patient Index Data 3 (RAPID3), Rheumatoid Arthritis Disease Activity Index (RADAI), Rapid Assessment of Disease Activity in Rheumatology (RADAR), Patient Reported Outcomes Measurement Information System (PROMIS),” they added. “Unfortunately, too many choices can paralyze a clinician into indecision, and choosing too many may increase patient burden to provide data that is not useful for their care.”
To analyze which clinical data rheumatologists use to inform treatment decisions for patients with RA, Jagpal and colleagues conducted a series of moderated group teleconference discussions with professionals across the country. Rheumatologists who treat patients with RA were recruited via email from a list of American College of Rheumatology members. Of the 325 rheumatologists identified by the researchers, 25 participated in four group sessions, with each group ranging in size from four to eight participants.
During the online group sessions, a trained moderator described the purpose of the study and presented the following question for discussion: “When seeing an established patient with RA in your office, from your personal perspective and professional practice, what elements of the patient’s history, signs, and symptoms are most helpful to you in making treatment recommendations for the management of RA?” The groups then generated lists of statements in response, including signs they typically use to inform their treatment decisions for RA. Each participant then selected three of the most important elements from their group’s list. The researchers later combined and summarized the results.
According to the researchers, the participants’ statements in response to the question could be categorized into 13 topics — symptoms, physical function, comorbidities, social aspects, physical findings, response to treatment, treatment adherence, pain management, side effects, tests, access to care, contraception and organ involvement — of which 10 received ranking votes. Patient-reported symptoms received the highest ranking, with 46% of the votes, followed by physical function, with 16%. Physical findings received 13% of votes and test results garnered 5%.
Treatment response and adherence each also received 5% of votes, side effects and comorbidities each received 4% and “other” — which included organ involvement, pain medication, access to care, contraception and social aspects, all combined — netted 2%.
“Rheumatologists value certain aspects related to RA to inform their treatment recommendations that can be measured through PROs,” Jagpal and colleagues wrote. “The results of this study will be used to develop a survey for rheumatologists to assess the generalizability of the findings. This research will serve as a foundation for the development of a user-friendly PROs data collection platform for the physicians to aid treatment decisions in RA. Such tools can facilitate the data collection for RA registries, implementation of the treat to target guidelines, and optimization of clinical care for patients with RA.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.