Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens.
Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens.
复制标题
类风湿关节炎患者接受或抵抗缓解疾病的抗风湿药物治疗方案的动机。
DOI：
10.1002/acr.23301
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发表时间：
2018
影响因子：
4.7
通讯作者：
Chang,JudyC
中科院分区：
文献类型：
--
作者：
Shaw,Yomei;Metes,IlincaD;Michaud,Kaleb;Donohue,JulieM;Roberts,MarkS;Levesque,MarcC;Chang,JudyC
患者拒绝和不遵守疾病缓解抗风湿药物（DMARD）治疗可能会对类风湿关节炎（RA）的疾病结局产生不利影响。这种定性研究描述了如何类风湿关节炎患者的感受，在响应的经验和信息影响他们的决定，接受（同意通过，启动和实施）或抵制（拒绝，避免和中止）DMARD治疗regiments.MethodsA共48例类风湿关节炎患者进行了采访，他们的经验决策DMARD。采访转录，编码，并分析了主题相关的内部动机接受或抵制治疗方案，使用叙事分析approach.ResultsIn除了感觉的必要性和危险的药物，病人的感觉，他们的身份作为一个生病的人，服药的行为，和决策过程本身是重要的驱动程序，病人的决定。对于患者接受治疗方案的动机，出现了2个主题：希望恢复正常生活，以及担心将来因RA而残疾。关于抵制治疗方案的动机，出现了5个主题：对药物的恐惧、对健康的控制、对病人身份的否认、对治疗的失望以及对决定的认知负担感到不知所措。结论对经历和信息的反应感受在患者如何权衡治疗方案的收益和成本方面发挥着重要作用，这表明，当风湿病学家建议治疗方案时，关注患者的感受可能很重要。需要进一步的研究来了解如何在整个治疗决策过程中最好地解决患者的感受。
ObjectivePatient refusal of and nonadherence to treatment with disease‐modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients’ feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens.MethodsA total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach.ResultsIn addition to feelings about the necessity and dangers of medications, patients’ feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients’ motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding.ConclusionFeelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients’ feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients’ feelings throughout the treatment decision‐making process.