The multidisciplinary format is supported by additional research, as well. Researchers concluded that to fully treat patients with RA and SLE, rheumatologists, psychiatrists and medical psychologists should work together to improve the clinical course and prognosis.10 And the psychosocial effects of psoriasis can be reduced if the patient attends a self-help organization or takes part in interdisciplinary patient education.6
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Explore This IssueApril 2015
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Shared Decision Making
It has long been recognized that patients better comply with treatment when they have the right education.11 Talking through the options and providing sufficient information are important so patients can participate in making decisions about their care and overcome their fears about medications. With regard to starting therapy with disease-modifying antirheumatic drugs (DMARDs) specifically, researchers in The Netherlands noted that patients may perceive that the therapy is aggressive or harmful, or they may worry about side effects, influence on fertility or pregnancy, the length of time the medication takes to be effective, how it is administered and issues associated with long-term treatment.12
“Few patients are quite active participants by nature; most patients are not even aware of having a choice,” says Ingrid Nota, PhD student, University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands. “Stating the decision to be made and which role the patient can have in the decision-making process (i.e., acknowledging the relevance of patient participation and supporting patients to increase their confidence/self-efficacy to fulfill that role) is the first, and maybe most important, step to take.”
Despite their fears about medications, patients have a strong desire to be educated about their options, particularly how a medication will affect their everyday life, according to Nota et al. “For rheumatologists, it is important to realize that not all patients want or are able to make the final choice for medication, but do have an opinion and preference on certain aspects of the medication,” Ms. Nota says. Critically, rheumatologists should ask the patient, “What matters to you when taking medication?” Ms. Nota explains.
Another study by Nota et al involved sending questionnaires to 894 patients with RA, psoriatic arthritis or ankylosing spondylitis, and the majority of respondents (response rate 58%) voiced a preference for shared decision making.13 Further, patients who felt involved in the choices about their treatment tended to be more satisfied with their care—even if they felt that they were involved in too many choices. Conversely, patients who were left feeling that they wanted to participate more were less satisfied with their care.
In the Know
In the end, it comes down to the fact that knowledge is empowering. The more the patient knows and understands, the more promising the outcomes. A recent study showed that higher baseline mindfulness (i.e., conscious understanding) among 201 patients with RA was significantly associated with less disability-related psychological distress at one year of follow-up.14