Researchers at the University of Michigan conducted a study in people with long-term rheumatoid arthritis to determine their preferred level of involvement in treatment decision making. The study was published in the journal Arthritis Care & Research.

Kevin C. Chung, MD, and colleagues at the University of Michigan Health System recruited 20 participants from the ongoing Silicone Arthroplasty in Rheumatoid Arthritis (SARA) study. Research assistants conducted semistructured in-person interviews with each participant. Interviews followed a guide and contained open-ended questions focusing on the patient’s initial diagnosis, medical treatment decision making, treatment satisfaction, and surgical decision making. Specifically, the research team sought to determine which decision-making model–either paternalistic decision making (PDM) or shared decision making (SDM)–was followed by those with long-term rheumatoid arthritis.

Of the 20 persons interviewed, 19 recalled using the PDM model directly after their diagnosis. Fourteen of those 19 evolved to an SDM model, attributing the change “to the development of a trusting relationship with their physician, as well as to becoming educated about the disease,” wrote Dr. Chung and colleagues.


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“When initially diagnosed with RA, patients may let their physician decide on the best treatment course,” the authors wrote. “Over time, patients may evolve to exercise a more collaborative role.”

The investigators emphasized that physicians should discuss the level of desired involvement with each patient. “Even within SDM, each patient can demonstrate a varied amount of autonomy,” they concluded.

Summary and Clinical Applicability

This study demonstrates a clear evolution in those with long-term rheumatoid arthritis from PDM to SDM decision making. Results of the study clarify the importance of educating those with rheumatoid arthritis, who often have entered into a lifelong physician-patient relationship because of the chronic nature of the disease. The results also emphasize the importance of finding a trustworthy and reliable physician, as study participants attributed their shift from PDM to SDM to both a better understanding of their disease and increased trust in their physicians.

Reference

Mathews AL, Coleska A, Burns PB, Chung KC. Evolution of patient decision-making regarding medical treatment of rheumatoid arthritis. Arthritis Care Res. 2016;68(3)318-324.