Do You and Your Patients Agree on Treatment Goals?

Rheumatologists need to work on their communication skills with patients, according to a study showing that physicians are much more likely to judge patients’ symptomatic states as “acceptable” before and after anti-TNF treatment than patients.

The study (RAPID-axSpA) confirms previous reports of similarly discrepant assessments, said Owen Davies, MD, the leader of axial spondyloarthritis medical affairs for UCB Pharma in the United Kingdom. During an interview conducted at his poster presentation on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Dr. Davies said:  “Perceptual differences between patients and physicians need to be understood in order to improve the patient-physician dialogue, set appropriate shared treatment goals and ultimately improve outcomes.”

The discordant assessments were uncovered in Dr. Davies’ study among 324 patients with adult onset axial spondyloarthritis. All had disease duration >3 months and had experienced treatment failure with 1 or more NSAIDs. The participants were treated (1:1:1) with 1 of 2 certolizumab pegol regimens or placebo. Researchers were investigating the proportion of axial spondyloarthritis patients with acceptable symptomatic states and differences in assessment between physicians and patients.

Patients’ symptoms “acceptability thresholds” were based on their global assessment of disease activity (PtGADA and PASS). At baseline, 6.6% of placebo patients and 10.1% of certolizumab pegol patients had an acceptable symptom state, according to patient assessment (PASS). According to physician assessment (PhSS), 35.8% of placebo patients and 37.6% of certolizumab pegol (combined) patients had an acceptable symptom state. After 24 weeks of treatment, levels of acceptable symptom states improved with certolizumab pegol, but the discrepancy in assessments persisted. Acceptable PASS levels were reported by 51.4% of patients receiving certolizumab pegol and by 21.7% of patients receiving placebo. Acceptable PhSS levels were reported for 75.2% of patients receiving certolizumab pegol and for 44.3% of patients receiving placebo.

The relatively low level of agreement between patient and physician assessment of acceptable symptomatic state was driven by a more frequent assessment of the patient’s status as “acceptable” by physicians.

“These findings highlight a need for closer partnership between physicians and patients to set shared treatment goals,” Dr. Davies said.

References:

Abstract 671 

– “Discrepancy Between Patients and Physicians Acceptable Symptomatic States in Axial Spondyloarthritis: Findings from the RAPID-AxSpA Study,"

 Owen Davies PhD. ACR/ARHP 2015.