Patients' Perspectives on Shared Decision-Making About Medications in Psoriatic Arthritis: An Interview Study

Daniel Sumpton, Michael Oliffe, Barry Kane, Geraldine Hassett, Jonathan C. Craig, Ayano Kelly, Allison Tong

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Objective: Decision-making regarding medications to manage psoriatic arthritis (PsA) is complex because of multiple disease manifestations and comorbidities. Fear of side effects from systemic medications and misalignment in priorities between patients with PsA and rheumatologists makes shared decision-making challenging. We aimed to describe the perspectives of patients with PsA on shared decision-making regarding medication taking. 

Methods: Face-to-face semistructured interviews were conducted with 25 adult patients with PsA in Australia. Transcripts were thematically analyzed. 

Results: Five themes were identified: lacking agency in decision-making (denied choice, knowledge asymmetry, desperation and necessity, restricted by unfair eligibility criteria, automated approach); overwhelmed by potential harms (daunted by aggressive therapy, anticipating lifestyle disruption from side effects, jeopardizing fertility and pregnancy, avoiding relapse); gaining confidence (discernible benefit in function and mental health, sharpening knowledge over time, expertise of family and peers, empowered by information); opting for alternatives (pursuing normality, suspicion of over-medicalization, seeking comprehensive solutions); and developing trust and fortifying collaboration (assurance through a personable approach, seeking consistency, supported in decisional power, resolution through respectful negotiation).

Conclusion: Patients with PsA lack agency in making treatment decisions and are overwhelmed by the potential harms of systemic medication. Improving knowledge and trust with medical teams in a supportive and collaborative environment, and strategies for managing risks and side effects may improve decision-making about pharmacologic management of PsA.

Original languageEnglish
Pages (from-to)2066-2075
Number of pages10
JournalArthritis Care and Research
Volume74
Issue number12
Early online date7 Jul 2022
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Decision theory
  • patient participation
  • shared decision making

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