An online decision tool helped two-thirds of rheumatoid arthritis patients decide whether to take methotrexate. But when it contradicted their preconceptions, it created conflict and delays.
Li LC, Adam PM, Backman CL, et al., A proof-of-concept study of ANSWER, a web-based methotrexate decision aid for patients with rheumatoid arthritis.Arthritis Care Res (Hoboken). 2014 Mar 12. doi: 10.1002/acr.22319. [Epub]
Studies link poorer rheumatoid arthritis (RA) outcomes such as irreversible joint damage and poorer physical function with delays of as little as three months in initiating anti-rheumatic disease modifying drugs (DMARDs) after a new diagnosis. American College of Rheumatology guidelines stress initiating treatment within six months. Yet evidence consistently shows that less than half of recently-diagnosed RA patients are taking DMARDs.
How much to patients' indecisiveness due to misunderstandings or misinformation about the medical options? In a small pilot study, an interactive online tool helped two-thirds of patients with early RA who were unsure about starting methotrexate (MTX) to make a firm decision.
Appropriately named ANSWER (for ANimated, Self-serve WEb-based Research tool), the website is a user-friendly decision aid created by the Arthritis Research Centre of Canada and the Universities of Ottawa and British Columbia. Designed to guide patients through the decision-making process, either at home or in the clinic, it features videos and other impartial information about the risks and benefits of MTX, aimed at patients of varying literacy levels. (http://answer.arccanada.org/).
A test group of 30 early RA patients, most women in their mid-50s, were allowed to use the tool at their own speed, repeating segments as needed. After using the ANSWER tool, 20 participants (66.6%) were able to make a decision, of whom 14 chose to take MTX. The other six chose not to, but said they would talk to their doctors about other treatment options. Ten participants (33.3%) remained unsure.
In interviews of 11 randomly selected participants, some said that the website gave them better knowledge about MTX and reduced their conflicts about making a decision. However, this can be an uphill battle: To the degree that the website conveyed information that contradicted their previous impressions and beliefs about RA (some of them probably inaccurate), it seemed to increase their frustration and reluctance to take MTX, further delaying treatment. The report does not state whether these conflicts were more common among patients who still couldn't make a decision after using the website.
"[O]ur findings suggest that user experience can be further improved by explicitly addressing myths about the disease and treatment options," write the authors.