PMS103 - Patients’ Preferences for Rheumatoid Arthritis Treatments and their Participation in the Treatment Decision-Making Process. A Systematic Review of the Literature

Abstract

To synthesize the available information on patients’ preferences for rheumatoid arthritis (RA) treatment and their participation in the treatment decision-making process. Electronic databases [PubMed, ISI-WOK, Cochrane Library, MEDES, IBECS, CSIC] and grey literature, were searched. Studies written in English or Spanish, published in Europe and North America between January 2005 and February 2015 were selected. Editorials, letters, opinion papers and studies performed on specific populations were excluded. The search resulted in 1,156 citations; 15 studies accomplished the selection criteria. Nine studies explored patients’ preferences for RA treatments characteristics (administration methods=7; frequency=2). Auto-injected devices that facilitated self-administration at home and improved comfort, and less frequent doses were preferred. Convenience (home administration and non-interference with everyday life) was the main reason for choosing subcutaneous routes, while safety, rapidity of action, reassurance and confidence were the reasons for choosing intravenous routes. Two publications examined the influence of patients’ characteristics on treatment status-quo. Patients who were moderately affected by RA were more open to consider new treatment alternatives. One study explored patients’ priorities regarding treatment outcomes. Less pain, joint damage or fatigue, daily life activities and more mobility were the prioritized outcomes. Three studies elicited preferences regarding patients’ participation in treatment decision-making, showing that they were negatively associated with age but positively associated with RA knowledge. Although patients preferred shared treatment decision-making, they reported that most of the physician-patients communication was centered on symptoms and impact of RA. Most patients valued treatment recommendations given by their physicians considering their expert knowledge and clinical experience. Unawareness of having a choice was the main barrier for patients’ participation in decision-making. Patients’ preferences are influenced by patients’ characteristics, clinical status and impact of RA in their daily life. Including patients’ preference and involving patients in treatment decision-making may contribute to better clinical outcomes.