Treat-to-target and shared decision making in rheumatoid arthritis treatment: Is it feasible?
Falzer PR; Department of Veterans Affairs, Clinical Epidemiology Research Center, VA Connecticut West Haven Campus, West Haven, CT, USA.
International journal of rheumatic diseases [Int J Rheum Dis] 2019 Sep; Vol. 22 (9), pp. 1706-1713. Date of Electronic Publication: 2019 Jul 30.
Typ publikacji :
Imprint Name(s) :
Original Publication: [Oxford, UK] : Wiley on behalf of the Asia Pacific League of Associations for Rheumatology
MeSH Terms :
Attitude of Health Personnel*
Decision Making, Shared*
Health Knowledge, Attitudes, Practice*
Antirheumatic Agents/*therapeutic use
Arthritis, Rheumatoid/*drug therapy
Adult ; Aged ; Aged, 80 and over ; Antirheumatic Agents/adverse effects ; Arthritis, Rheumatoid/diagnosis ; Clinical Decision-Making ; Cost of Illness ; Disability Evaluation ; Female ; Humans ; Judgment ; Male ; Middle Aged ; Pain Measurement ; Remission Induction ; Severity of Illness Index ; Treatment Outcome ; Young Adult
Lewiecki EM, Cummings SR, Cosman F. Treat-to-target for osteoporosis: is now the time? J Clin Endocrinol Metab. 2013;98(3):946-953.
Sitbon O, Galie N. Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals. Eur Respir Rev. 2010;19(118):272-278.
Atar D, Birkeland KI, Uhlig T. ‘Treat to target’: moving targets from hypertension, hyperlipidaemia and diabetes to rheumatoid arthritis. Ann Rheum Dis. 2010;69(4):629-630.
Singh JA, Saag KG, Bridges SL, et al. 2015 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960-977.
Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364(9430):263-269.
Schoels M, Knevel R, Aletaha D, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search. Ann Rheum Dis. 2010;69(4):638-643.
Stoffer MA, Schoels MM, Smolen JS, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. Ann Rheum Dis. 2016;75(1):16-22.
Wailoo A, Hock ES, Stevenson M, et al. The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2017;21(71):1-258.
Schipper LG, van Hulst L, Grol R, van Riel P, Hulscher M, Fransen J. Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcome. Rheumatology. 2010;49(11):2154-2164.
Pincus T, Castrejón I, Bergman MJ, Yazici Y. Treat-to-target: not as simple as it appears. Clin Exp Rheumatol. 2012;30(suppl 73):S10-20.
Huizinga T, Knevel R. Rheumatoid arthritis: 2014 treat-to-target RA recommendations - strategy is key. Nat Rev Rheumatol. 2015;11(9):509-511.
Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. Milbank Q. 2004;82(4):661-687.
Siemons L, Ten Klooster PM, Vonkeman HE, Glas CA, Van de Laar M. Distinct trajectories of disease activity over the first year in early rheumatoid arthritis patients following a treat-to-target strategy. Arthritis Care Res. 2014;66(4):625-630.
Naranjo A, Cáceres L, Hernández-Beriaín JÁ, et al. Factors associated with the intensification of treatment in rheumatoid arthritis in clinical practice. Rheumatol Int. 2015;35(11):1851-1855.
Solomon DH, Bitton A, Katz JN, Radner H, Brown EM, Fraenkel L. Review: treat to target in rheumatoid arthritis: fact, fiction, or hypothesis? Arthritis Rheumatol. 2014;66(4):775-782.
Rosenbaum J. Is shared decision making possible in rheumatology? The Rheumatologist. 2014;1-3.
Kleinman A. Explanatory models in health-care relationships: A conceptual frame for research on family-based health-care activities in relation to folk and professional forms of clinical care. In: Stoeckle JD, ed. Encounters Between Patients and Doctors: An Anthology. Boston, MA: MIT Press; 1987:273-286.
Silver WS, Mitchell TR. The status quo tendency in decision making. Organ Dyn. 1990;18(4):34-46.
Ahlstrand I, Vaz S, Falkmer T, Thyberg I, Björk M. Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis. Clin Rehabil. 2017;31(6):824-834.
Ahlmén M, Nordenskiöld U, Archenholtz B, et al. Rheumatology outcomes: the patient's perspective. A multicenter focus group interview study of Swedish rheumatoid arthritis patients. Rheumatology. 2005;44(1):105-110.
Dougados M, Nataf H, Steinberg G, Rouanet S, Falissard B. Relative importance of doctor-reported outcomes vs patient-reported outcomes in DMARD intensification for rheumatoid arthritis: the DUO study. Rheumatology. 2013;52:391-399.
Wolfe F, Michaud K. Resistance of rheumatoid arthritis patients to changing therapy: discordance between disease activity and patients' treatment choices. Arthritis Rheum. 2007;56(7):2135-2142.
van Hulst L, Kievit W, van Bommel R, van Riel P, Fraenkel L. Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: results of a maximum difference scaling experiment. Arthritis Care Res. 2011;63(10):1407-1414.
Falzer PR. Implementing treat-to-target practices for chronic pain through shared decision making: requisites, prospects, and challenges. Pain Pract. 2017;17(2):214-228.
Pincus T, Yazici Y, Bergman M. A practical guide to scoring a multi-dimensional health assessment questionnaire (MDHAQ) and routine assessment of patient index data (RAPID) scores in 10-20 seconds for use in standard clinical care, without rulers, calculators, websites or computers. Best Pract Res Clin Rheumatol. 2007;21(4):755-787.
Endsley MR. Toward a theory of situation awareness in dynamic systems. Hum Factors. 1995;37(1):32-64.
Dreyfus SE. Formal models vs human situational understanding: inherent limitations on the modeling of business expertise. 1981. (ORC 81-3). Available from: http://www.dtic.mil/dtic/tr/fulltext/u2/a097468.pdf.
Nemeth C, O'Connor M, Klock PA, Cook R. Discovering healthcare cognition: the use of cognitive artifacts to reveal cognitive work. Org Studies. 2006;27(7):1011-1035.
Stubbings L, Chaboyer W, McMurray A. Nurses' use of situation awareness in decision-making: an integrative review. J Adv Nurs. 2012;68(7):1443-1453.
Salmon PM. What is really going on? Review of situation awareness models for individuals and teams. Theor Issues Ergon Sci. 2008;9(4):297-323.
Leventhal HL, Diefenbach M, Leventhal EA. Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res. 1992;16(2):143-163.
Pincus T, Yazici Y, Bergman M, Maclean R, Harrington T. A proposed continuous quality improvement approach to assessment and management of patients with rheumatoid arthritis without formal joint counts, based on quantitative routine assessment of patient index data (RAPID) scores on a multidimensional health assessment questionnaire (MDHAQ). Best Pract Res Clin Rheumatol. 2007;21(4):789-804.
Leventhal HL, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. In: Cameron LD, Leventhal HL, eds. The Self-Regulation of Health and Illness Behaviour. New York, NY: Routledge; 2003.
Studenic P, Radner H, Smolen JS, Aletaha D. Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis Rheum. 2012;64(9):2814-2823.
Pincus T, Yazici Y, Bergman M, Swearingen C, Harrington T. A proposed approach to recognise "near-remission" quantitatively without formal joint counts or laboratory tests: a patient self-report questionnaire routine assessment of patient index data (RAPID) score as a guide to a "continuous quality improvement". Clin Exp Rheumatol. 2006;24(6 suppl 43):S-60-5.
Sanderson T, Morris M, Calnan M, Richards P, Hewlett S. What outcomes from pharmacologic treatments are important to people with rheumatoid arthritis? Creating the basis of a patient core set. Arthritis Care Res. 2010;62(5):640-646.
Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631-637.
Richmond SM, Bissell BL, Beach LR. Image theory's compatibility test and evaluations of the status quo. Organ Behav Hum Decis Process. 1998;73(1):39-53.
Beach LR. The Psychology of Narrative Thought: How the Stories We Tell Ourselves Shape Our Lives. Bloomington, USA:Xlibris. 2010.
SPSS Inc. SPSS statistics for Windows. 21.0 ed. Armonk, NY: IBM Corporation; 2012.
Cohen J. Multiple regression as a general data-analytic system. Psychol Bull. 1968;70(6):426-443.
Neogi T, Felson DT. Composite versus individual measures of disease activity in rheumatoid arthritis. J Rheumatol. 2008;35(2):185-187.
Klein G, Wiggins S, Dominguez CO. Team sensemaking. Theor Issues Ergon Sci. 2010;11(4):304-320.
Sorensen LJ, Stanton NA. Is SA shared or distributed in team work? An exploratory study in an intelligence analysis task. Int J Ind Ergon. 2011;41(6):677-687.
Kitchin J, Baber C. A comparison of shared and distributed situation awareness in teams through the use of agent-based modelling. Theor Issues Ergon Sci. 2016;17(1):8-41.
Desthieux C, Hermet A, Granger B, Fautrel B, Gossec L. Patient-physician discordance in global assessment in rheumatoid arthritis: a systematic literature review with meta-analysis. Arthritis Care Res. 2016;68(12):1767-1773.
Robinson SM, Walker DJ. Negotiating targets with patients: choice of target in relation to occupational state. Rheumatology. 2012;51(2):293-296.
Grant Information :
Contributed Indexing :
Keywords: chronic illness treatment; evidence-based medicine; naturalistic decision making; practice guidelines; progress assessment; rheumatoid arthritis; shared decision making; situation awareness; treat-to-target
Substance Nomenclature :
0 (Antirheumatic Agents)
Entry Date(s) :
Date Created: 20190731 Date Completed: 20200219 Latest Revision: 20200219
Update Code :
Aim: Current rheumatoid arthritis (RA) guidelines have incorporated a treat-to-target (T2T) approach and require that it be implemented through shared decision making (SDM). Current discourse has questioned whether collaborative T2T is feasible in RA, in part because of discrepancies in the way that patients and practitioners assess progress and decide whether to consider a change in the current treatment. A previous study found that patients' willingness to change is directly associated with their disease activity (DA) scores. The current study continues this line of research by developing and testing a model that describes the role of DA and illness beliefs on RA patients' progress assessments.
Method: A questionnaire administered to 156 patients with RA included a self-assessed DA measure (Rapid-4), an illness belief battery (BIPQ), and a progress assessment question. These items populated a descriptive model, based on situation awareness (SA) theory. It posits that progress assessment scores are products of 3 sequential steps: perception, understanding, and forecasting. The first 2 steps were measured by DA scores, the 3rd by illness beliefs. The model was tested using general linear model techniques.
Results: All six measures were significantly related to progress assessment scores. The full SA model accounted for over 50% of the variance. The best fitting model included a pain measure at step 1, global disability at step 2, and illness beliefs at step 3.
Conclusion: Findings suggest that implementing T2T through SDM is feasible, that there is substantial commonality between how patients and practitioners assess progress, and that discrepancies may be complementary and addressed through interaction. The SA model helps to explain previous findings about the influence of illness beliefs on patients' judgments. It is suggested that future studies acknowledge the feasibility of collaborative T2T and focus attention on how it can work more effectively and comprehensively.
(© Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)
Zaloguj się, aby uzyskać dostęp do pełnego tekstu.