Patient Decision Aid (PDA) for Patients with Rheumatoid Arthritis Reduces Decisional Confict and Improves Readiness for Treatment Decision Making

Abstract

Objectives The aim of this study was to develop and assess the efectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efcacy using the Decisional Confict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarifcation section. Alphatesting revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA signifcantly reduced overall patients’ decisional confict [33.2 (DE: 21.4) vs 24.6 (23.5); p<0.001] and prepared the patient for decision making [PDMS: 67.5 (21.0)]. Conclusions We developed a PDA for Spanish patients with moderate-to-severe RA that reduces patients’ decisional confict and increases their readiness for decision making. The use of this PDA in routine clinical practice may improve the quality of the decision-making process and the quality of the choices made.