Experience and context shape patient and clinician goals for treatment of rheumatoid arthritis: a qualitative study.

OBJECTIVE

Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians.

METHODS

Seven focus groups and one semi-structured interview were conducted with RA patients and clinicians recruited from four 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

19 patients (mean age 55; 74% female; 32% nonwhite; 26% Spanish speakers) and 18 clinicians (44% trainees; 44% female; 28% nonwhite) participated. Across clinician and patient focus groups, two domains were identified: 1) patient knowledge of RA and 2) psychosocial dynamics (stress) in RA treatment. Within the knowledge domain, three themes emerged: 1) RA knowledge for informed choice; 2) RA knowledge to ensure adherence and medication safety; and 3) clinician assumption of patient inability to interpret information. Within the second domain of RA and stress, two themes emerged: 1) patient's illness experience informs treatment context in ways not shared by clinicians; and 2) 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, mismatch 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. This article is protected by copyright. All rights reserved.