Rheumatologist and Patient Mental Models for Treatment of Rheumatoid Arthritis Help Explain Low Treat-to-Target...

Area of Science:

• Rheumatology
• Health Communication
• Patient-Centered Care

Background:

• Treat-to-target (TTT) strategy offers proven benefits for rheumatoid arthritis (RA) management.
• Less than half of RA patients are currently treated using the TTT approach, indicating a gap in implementation.

Purpose of the Study:

• To identify critical discrepancies between rheumatologist and patient mental models in RA treatment.
• To inform interventions aimed at increasing the implementation of the TTT strategy.

Main Methods:

• Developed rheumatologist and patient mental models using the Mental Models Approach to Risk Communication.
• Conducted semistructured interviews with 14 rheumatologists and 30 RA patients.
• Analyzed survey responses (n=284) to supplement interview data, with independent coding of transcripts.

Main Results:

• Both rheumatologist and patient mental models are more complex than the standard TTT model.
• Decision-making incorporates factors beyond disease activity, such as system factors and patient readiness.
• Unique factors emerged: physicians emphasize disease activity over time and adherence; patients highlight disease weariness, medication fatigue, feeling informed, and medication change stress.

Conclusions:

• Significant discrepancies exist between patient and physician mental models, particularly concerning information gaps and differing valuation of trade-offs.
• These identified discrepancies offer specific targets for improving patient-physician communication.
• Addressing these communication gaps is crucial for enhancing the uptake of the treat-to-target strategy in RA management.