Treatment choices, preferences and decision-making by patients with rheumatoid arthritis
Treatment choices, preferences and decision-making by patients with rheumatoid arthritis
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DOI：
10.1002/msc.110
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发表时间：
2008-03-01
影响因子：
1.3
通讯作者：
Collett, Raymond A.
中科院分区：
文献类型：
--
作者：
Chilton, Frances;Collett, Raymond A.
目的：探讨类风湿关节炎（RA）患者的治疗偏好，他们的决策和治疗选择，他们会面对三个抗肿瘤坏死因子-α（TNF-α）therapy.Methods：两种方法的查询：邮寄问卷和一对一的访谈。要求未服用抗TNF-α药物的RA患者在阅读书面方案后完成一份问卷，其中涉及从三种抗TNF-α治疗中选择和确定影响其治疗选择的因素：依那西普（Enbrel）、阿达木单抗（Humira）和英夫利昔单抗（Remicade）。曾尝试过一种以上的抗TNF-α药物的患者在一对一的采访中询问他们的治疗偏好，以及他们目前的治疗方法是如何决定的。结果：受访者和问卷调查受访者都选择阿达木单抗作为他们的首选治疗。受访者认为缺乏控制、便利性和技术问题是影响治疗选择的因素。问卷调查的受访者比受访者更不愿意参与选择抗TNF-α治疗的决策。几乎没有性别差异。年龄小于61岁的患者对自我给药治疗更有信心，更喜欢皮下（sc）而不是静脉（iv）给药，因为这减少了定期住院。老年患者更喜欢医护人员管理治疗和更容易识别的“与其他患者/会议其他人的接触”和“工作人员的可用性，如果出现问题”作为影响因素choice.Conclusions：RA患者表现出明确的治疗偏好。不同的因素影响患者选择皮下给药与静脉给药相比。许多RA患者在选择抗TNF-α治疗时希望分享治疗决策或放弃对健康专业人员的责任。患者需要安慰和与临床医生持续对话，以最佳方式管理他们的病情。版权所有（C）2007约翰威利父子有限公司
Objectives: To explore rheumatoid arthritis (RA) patient treatment preferences, their decision-making and the treatment choices they would make when faced with three antitumour necrosis factor-alpha (TNF-alpha) therapy options.Methods: Two methods of enquiry were used: postal questionnaire and one-to-one interviews. RA patients not taking anti-TNF-alpha medications were asked to complete a questionnaire after reading a written scenario, which involved choosing and identifying factors that influenced their treatment choice from three anti-TNF-alpha therapies: etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). Patients who had tried more than one anti-TNF-alpha medication were asked at one-to-one interviews for their treatment preferences and how their current treatment had been decided.Results: Both interviewees and questionnaire respondents chose adalimumab as their preferred treatment. Interviewees identified lack of control, convenience and technical issues as influencing treatment choice. Questionnaire respondents were less likely than interviewees to want to participate in making decisions about the selection of anti-TNF-alpha therapy. There were few gender differences. Patients younger than 61 years old were more confident about self-administering treatment, and preferred subcutaneous (sc) over intravenous (iv) medication, as this reduced regular hospital attendance. Older patients preferred health care staff to administer treatment and more readily identified 'contact with other patients/meeting others' and 'staff availability if problems arise' as factors influencing choice.Conclusions: RA patients demonstrate a clear treatment preference. Different factors influence patients who choose sc compared with iv medications. Many RA patients either wished to share in treatment decisions or relinquish responsibility to the health professional when choosing anti-TNF-alpha therapy. Patients require reassurance and continuing dialogue with clinicians to manage their condition optimally. Copyright (C) 2007 John Wiley & Sons, Ltd.