Health Services Research & Development

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Barton JL, Hulen E, Schue A, Yelin EH, Ono SS, Tuepker A, Koenig CJ. Experience and Context Shape Patient and Clinician Goals For Treatment of Rheumatoid Arthritis: A Qualitative Study. Arthritis care & research. 2018 Nov 1; 70(11):1614-1620.
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Abstract: OBJECTIVE: Alignment of patient and clinician goals, which is central to effective patient-centered care, has been linked to improved patient experience and outcomes but has not been explored in rheumatoid arthritis (RA). The aim of this study was to analyze goal conceptualization among RA patients and clinicians. METHODS: Seven focus groups and 1 semi-structured interview were conducted with RA patients and clinicians who were recruited from 4 rheumatology clinics. An interview guide was developed to explore goal concordance related to RA treatment. Researchers utilized a concurrent deductive-inductive data analysis approach. RESULTS: Nineteen patients (mean age 55 years, 74% female, 32% non-white, and 26% Spanish-speaking) and 18 clinicians (44% trainees, 44% female, 28% non-white) participated. Across clinician and patient focus groups, the 2 identified domains were patient knowledge of RA and psychosocial dynamics (stress) in RA treatment. Within the knowledge domain, 3 themes emerged: RA knowledge for informed choice, RA knowledge to ensure adherence and medication safety, and clinician assumption of patient inability to interpret information. Within the second domain of RA and stress, 2 themes emerged: patient illness experience informs treatment context in ways that are not shared by clinicians, and the impact of patient-clinician communication and decision-making on goal concordance. CONCLUSION: Knowledge is a shared goal, but RA patients and clinicians hold divergent attitudes towards this goal. While knowledge is integral to self-management and effective shared decision-making, mismatches in attitudes may lead to suboptimal communication. Tools to support patient goal-directed RA care may promote high quality patient-centered care and result in reduced disparities.