Patient-Centered OA: What About Patient Preferences?

Jennifer M. Gierisch, Evan R. Myers, Kristine M. Schmit, et al. Prioritization of Patient-Centered Comparative Effectiveness Research for Osteoarthritis. Ann Intern Med. 13 May 2014 doi:10.7326/M14-0318
 

What are the most important outcomes for patients with foot, ankle, knee or hip osteoarthritis (OA)? How does OA and treatment affect sleep, negative affect, depression, and worry? How does it affect activities of daily living? Return to work? Quality of life? Pain? Research on OA treatment has not addressed these patient concerns.

There is little research about patients’ own preferences.

Those are the conclusions of a report funded by the Patient-Centered Outcomes Research Institute (PCORI), which engaged a group of 13 “stakeholders”- including clinical experts and researchers, professional societies, and consumer and patient advocacy groups to find gaps in research. They were ranked by priority, and researchers reviewed recent and ongoing studies to see how well they were addressing these issues.

OA is a long-term, chronic disease, but most studies are short-term.

Research should focus on patients’ needs across the spectrum of the disease, from disease identification, treatment decisions, and the transition from nonsurgical to surgical interventions.

Stakeholders wanted future research to focus on engaging patients early in the disease process, and help patients navigate treatment options that optimize those patient-centered outcomes. They wanted strategies that promote successful long-term engagement in nonsurgical treatment.

They also emphasized the importance of setting patients up for success-not failure. Treatments should be tailored to patients’ abilities, insurance coverage, culture, and preferences.

The most highly-ranked research needs focused on optimizing the duration, intensity and frequency of nonsurgical interventions that create sustained changes in patient-centered outcomes. What are the tradeoffs, for example in patient time required for frequent visits, or sacrifices required for dietary modification?

The report found 48 research topics, and divided them into Tables with a top tier of 12 highest-ranked priorities, a middle tier of 18 priorities, and a lower tier of 18 priorities.
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