Treat-to-target and shared decision making in rheumatoid arthritis treatment: Is it feasible?

Current rheumatoid arthritis (RA) guidelines have incorporated a treat-to-target (T2T) approach and require that it be implemented through shared decision making (SDM). Current discourse has questioned whether collaborative T2T is feasible in RA, in part because of discrepancies in the way that patients and practitioners assess progress and decide whether to consider a change in the current treatment. A previous study found that patients' willingness to change is directly associated with their disease activity (DA) scores. The current study continues this line of research by developing and testing a model that describes the role of DA and illness beliefs on RA patients' progress assessments.

A questionnaire administered to 156 patients with RA included a self-assessed DA measure (Rapid-4), an illness belief battery (BIPQ), and a progress assessment question. These items populated a descriptive model, based on situation awareness (SA) theory. It posits that progress assessment scores are products of 3 sequential steps: perception, understanding, and forecasting. The first 2 steps were measured by DA scores, the 3rd by illness beliefs. The model was tested using general linear model techniques.

All six measures were significantly related to progress assessment scores. The full SA model accounted for over 50% of the variance. The best fitting model included a pain measure at step 1, global disability at step 2, and illness beliefs at step 3.

Findings suggest that implementing T2T through SDM is feasible, that there is substantial commonality between how patients and practitioners assess progress, and that discrepancies may be complementary and addressed through interaction. The SA model helps to explain previous findings about the influence of illness beliefs on patients' judgments. It is suggested that future studies acknowledge the feasibility of collaborative T2T and focus attention on how it can work more effectively and comprehensively.