Canadian Rheumatologists Iffy About Patient Decision Aids

May 12, 2015

People have been busy creating decision aids to help involve patients in treatment choices. But rheumatologists prove lukewarm to the whole idea so far.

Zong JY, Leese J, Klemm A, et al., Rheumatologists' Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice. Arthritis Care & Research. 2015;Accepted article, online May 4.  doi: 10.1002/acr.22605.

Both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) strongly support shared decision-making between patients and physicians.  EULAR feels that decision-sharing “is of such overwhelming importance” that it topped the list of overarching principles in 2013 revised guidelines for managing rheumatoid arthritis (RA).

The website of the Patient Decision Aids Research Group at the Ottawa Hospital Research Institute lists 9 patient decision aids (PtDAs) created to help with this process. But researchers at the University of British Columbia find that few doctors find them useful in clinical practice.

Almost 70% feel it would disrupt their workflow, their survey shows.

Respondents said PtDAs are no different than other patient education tools.

They find limited real-life value in these aids, because they are based on data from clinical trials. Respondents also fear that PtDAs could impair doctor-patient communication.

The biggest barriers to use: Time required to show patients how to use a PtDA, unfamiliarity with the content, and frequent lack of tools to support specific treatment decisions.

The team surveyed a cross section of more than 100 members of the Canadian Rheumatology Association (CRA) online and conducted 10 personal interviews. Around half of the rheumatologists were males, age 50 and older, practicing in a multidisciplinary setting.

This is disapointing news for the these researchers, some of whom reported last year in a proof-of-concept study that some videos they had created helped 60% of test subjects with RA to come to a decision about taking methotrexate.

They note that a 2014 Cochrane systematic review found patients who use decision-making aids less uncertain about their treatment choices and more likely to decide on a treatment with their physician.