Decision Aid-Led Tapering of Biologic and Targeted Synthetic DMARDs in Rheumatoid Arthritis: A Qualitative Study.

ABSTRACT

OBJECTIVE: To explore the experiences and perspectives of patients and rheumatologists on decision aid-led tapering of advanced therapy in rheumatoid arthritis (RA). METHODS: Semi-structured interviews were completed with patients and rheumatologists, embedded within a pilot study of decision aid-led tapering (i.e. dose reduction) of biologic and targeted synthetic (b/ts) DMARDs in RA. All patients were in sustained (>= 6 months) remission and had chosen to reduce their therapy after a decision aid-led shared decision with their rheumatologist. The rheumatologists included those participating in the pilot (n=4), and those who were not. Reflexive thematic analysis of audiotaped and transcribed interviews identified themes in the group experiences. RESULTS: Patients (n=10; 6 female) unanimously found the decision aid easy to understand and felt confident in shared decision-making about treatment tapering and managing flares. Rheumatologists' (n=12; 5 female) perspectives on tapering b/ts DMARDs varied widely, from very supportive to completely opposed, and influenced their views on the decision aid. Rheumatologists expressed concerns about patient comprehension, destabilizing a stable situation, risks of flare, and extending appointment times. Despite their initial reservations about sending the decision aid to all eligible patients ahead of appointments, three of four participating rheumatologists adopted this approach during the pilot, which had the benefit of facilitating patient-led conversations. CONCLUSION: A decision aid-led strategy for tapering advanced therapy in RA was acceptable to patients and feasible in practice. Sending patients a decision aid ahead of their appointment facilitated patient-led conversations about tapering.