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Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Rheumatoid arthritis patient perceptions on the value of predictive testing for treatments: a qualitative study

Authors: Kanta Kumar, Sarah Peters, Anne Barton, on behalf of MATURA

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

Rheumatoid arthritis (RA) is a long term condition that requires early treatment to control symptoms and improve long-term outcomes. Lack of response to RA treatments is not only a waste of healthcare resources, but also causes disability and distress to patients. Identifying biomarkers predictive of treatment response offers an opportunity to improve clinical decisions about which treatment to recommend in patients and could ultimately lead to better patient outcomes. The aim of this study was to explore the understanding of and factors affecting Rheumatoid Arthritis (RA) patients’ decisions around predictive treatment testing.

Methods

A qualitative study was conducted with a purposive sample of 16 patients with RA from three major UK cities. Four focus groups explored patient perceptions of the use of biomarker tests to predict response to treatments. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis by three researchers.

Results

Data were organised within three interlinking themes: [1] Perceptions of predictive tests and patient preference of tests; [2] Utility of the test to manage expectations; [3] The influence of the disease duration on take up of predictive testing. During consultations for predictive testing, patients felt they would need, first, careful explanations detailing the consequences of untreated RA and delayed treatment response and, second, support to balance the risks of tests, which might be invasive and/or only moderately accurate, with the potential benefits of better management of symptoms.

Conclusions

This study provides important insights into predictive testing. Besides supporting clinical decision making, the development of predictive testing in RA is largely supported by patients. Developing strategies which communicate risk information about predictive testing effectively while reducing the psychological burden associated with this information will be essential to maximise uptake.
Literature
1.
go back to reference Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford). 2002;41(7):793–800.CrossRef Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford). 2002;41(7):793–800.CrossRef
2.
go back to reference Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509.CrossRefPubMed Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509.CrossRefPubMed
3.
go back to reference Gonzalez-Alvaro I, Ortiz AM, Seoane IV, Garcia-Vicuna R, Martinez C, Gomariz RP. Biomarkers predicting a need for intensive treatment in patients with early arthritis. Curr Pharm Des. 2015;21(2):170–81.CrossRefPubMed Gonzalez-Alvaro I, Ortiz AM, Seoane IV, Garcia-Vicuna R, Martinez C, Gomariz RP. Biomarkers predicting a need for intensive treatment in patients with early arthritis. Curr Pharm Des. 2015;21(2):170–81.CrossRefPubMed
4.
go back to reference Barrera P, van der Maas A, van Ede AE, Kiemeney BA, Laan RF, van de Putte LB, et al. Drug survival, efficacy and toxicity of monotherapy with a fully human anti-tumour necrosis factor-alpha antibody compared with methotrexate in long-standing rheumatoid arthritis. Rheumatology (Oxford). 2002;41(4):430–9.CrossRef Barrera P, van der Maas A, van Ede AE, Kiemeney BA, Laan RF, van de Putte LB, et al. Drug survival, efficacy and toxicity of monotherapy with a fully human anti-tumour necrosis factor-alpha antibody compared with methotrexate in long-standing rheumatoid arthritis. Rheumatology (Oxford). 2002;41(4):430–9.CrossRef
5.
go back to reference Hyrich KL, Watson KD, Silman AJ, Symmons DP. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford). 2006;45(12):1558–65.CrossRef Hyrich KL, Watson KD, Silman AJ, Symmons DP. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford). 2006;45(12):1558–65.CrossRef
6.
go back to reference Visvanathan K, Chlebowski RT, Hurley P, Col NF, Ropka M, Collyar D, et al. American society of clinical oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol. 2009;27(19):3235–58.CrossRefPubMedPubMedCentral Visvanathan K, Chlebowski RT, Hurley P, Col NF, Ropka M, Collyar D, et al. American society of clinical oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol. 2009;27(19):3235–58.CrossRefPubMedPubMedCentral
7.
go back to reference Jani M, Gavan S, Chinoy H, Dixon WG, Harrison B, Moran A et al. A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice. Rheumatology (Oxford). 2016. pp. 113-9. doi:10.1093/rheumatology/kew292. Jani M, Gavan S, Chinoy H, Dixon WG, Harrison B, Moran A et al. A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice. Rheumatology (Oxford). 2016. pp. 113-9. doi:10.​1093/​rheumatology/​kew292.
8.
go back to reference Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53.CrossRefPubMed Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45–53.CrossRefPubMed
9.
go back to reference Greenhalgh T, Campbell-Richards D, Vijayaraghavan S, Collard A, Malik F, Griffin M, et al. New models of self-management education for minority ethnic groups: pilot randomized trial of a story-sharing intervention. J Health Serv Res Policy. 2011;16(1):28–36.CrossRefPubMed Greenhalgh T, Campbell-Richards D, Vijayaraghavan S, Collard A, Malik F, Griffin M, et al. New models of self-management education for minority ethnic groups: pilot randomized trial of a story-sharing intervention. J Health Serv Res Policy. 2011;16(1):28–36.CrossRefPubMed
10.
go back to reference Lewis JR, Konda V, Rubin DT. Genetic testing for inflammatory bowel disease: focus group analysis of patients and family members. Genet Test Mol Biomarkers. 2009;13(4):495–503.CrossRefPubMed Lewis JR, Konda V, Rubin DT. Genetic testing for inflammatory bowel disease: focus group analysis of patients and family members. Genet Test Mol Biomarkers. 2009;13(4):495–503.CrossRefPubMed
11.
go back to reference Adriaanse MC, Snoek FJ. The psychological impact of screening for type 2 diabetes. Diabetes Metab Res Rev. 2006;22(1):20–5.CrossRefPubMed Adriaanse MC, Snoek FJ. The psychological impact of screening for type 2 diabetes. Diabetes Metab Res Rev. 2006;22(1):20–5.CrossRefPubMed
12.
go back to reference Heshka JT, Palleschi C, Howley H, Wilson B, Wells PS. A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genet Med. 2008;10(1):19–32.CrossRefPubMed Heshka JT, Palleschi C, Howley H, Wilson B, Wells PS. A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genet Med. 2008;10(1):19–32.CrossRefPubMed
13.
go back to reference Markowitz SM, Park ER, Delahanty LM, O’Brien KE, Grant RW. Perceived impact of diabetes genetic risk testing among patients at high phenotypic risk for type 2 diabetes. Diabetes Care. 2011;34(3):568–73.CrossRefPubMedPubMedCentral Markowitz SM, Park ER, Delahanty LM, O’Brien KE, Grant RW. Perceived impact of diabetes genetic risk testing among patients at high phenotypic risk for type 2 diabetes. Diabetes Care. 2011;34(3):568–73.CrossRefPubMedPubMedCentral
14.
go back to reference Kasparian NA, Meiser B, Butow PN, Job RF, Mann GJ. Better the devil you know? High-risk individuals’ anticipated psychological responses to genetic testing for melanoma susceptibility. J Genet Couns. 2006;15(6):433–47.CrossRefPubMed Kasparian NA, Meiser B, Butow PN, Job RF, Mann GJ. Better the devil you know? High-risk individuals’ anticipated psychological responses to genetic testing for melanoma susceptibility. J Genet Couns. 2006;15(6):433–47.CrossRefPubMed
15.
go back to reference Honey S, Hill K, Murray J, Craigs C, House A. Patients’ responses to the communication of vascular risk in primary care: a qualitative study. Prim Health Care Res Dev. 2015;16(1):61–70.CrossRefPubMed Honey S, Hill K, Murray J, Craigs C, House A. Patients’ responses to the communication of vascular risk in primary care: a qualitative study. Prim Health Care Res Dev. 2015;16(1):61–70.CrossRefPubMed
16.
go back to reference Eborall H, Davies R, Kinmonth AL, Griffin S, Lawton J. Patients’ experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007;335(7618):490.CrossRefPubMedPubMedCentral Eborall H, Davies R, Kinmonth AL, Griffin S, Lawton J. Patients’ experiences of screening for type 2 diabetes: prospective qualitative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007;335(7618):490.CrossRefPubMedPubMedCentral
17.
go back to reference Eborall HC, Griffin SJ, Prevost AT, Kinmonth AL, French DP, Sutton S. Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007;335(7618):486.CrossRefPubMedPubMedCentral Eborall HC, Griffin SJ, Prevost AT, Kinmonth AL, French DP, Sutton S. Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ. 2007;335(7618):486.CrossRefPubMedPubMedCentral
18.
go back to reference Stack RJ, Shaw K, Mallen C, Herron-Marx S, Horne R, Raza K. Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature. Ann Rheum Dis. 2012;71(4):493–7.CrossRefPubMed Stack RJ, Shaw K, Mallen C, Herron-Marx S, Horne R, Raza K. Delays in help seeking at the onset of the symptoms of rheumatoid arthritis: a systematic synthesis of qualitative literature. Ann Rheum Dis. 2012;71(4):493–7.CrossRefPubMed
Metadata
Title
Rheumatoid arthritis patient perceptions on the value of predictive testing for treatments: a qualitative study
Authors
Kanta Kumar
Sarah Peters
Anne Barton
on behalf of MATURA
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1319-x

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