TY - JOUR
T1 - Shared decision-making in gout treatment
T2 - a national study of rheumatology provider opinion and practice
AU - Singh, Jasvinder A.
AU - Richards, John S.
AU - Chang, Elizabeth
AU - Toupin-April, Karine
AU - Barton, Jennifer L.
N1 - Publisher Copyright:
© 2020, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
PY - 2021/2
Y1 - 2021/2
N2 - To assess rheumatologists’ views and practices related to shared decision-making (SDM) in gout treatment. We performed a cross-sectional electronic survey of rheumatologists at U.S. Veterans Affairs (VA) medical centers, assessing views and practices related to SDM in gout. Of the 154 VA rheumatology providers eligible, 90 responded (response rate, 58%). Fifty-eight percent were female, the mean age was 51 years (standard deviation, 9.6), 42% had > 20 years of experience in medical practice. Rheumatologists reported routinely offering a choice to their patients for (1) starting urate-lowering therapy (ULT) for gout vs. doing nothing (70%); (2) choosing NSAIDs, corticosteroids, or colchicine for the treatment of acute flares (67%); and (3) choosing NSAIDs, corticosteroids, or colchicine for anti-inflammatory prophylaxis when starting ULT (51%). Very few rheumatologists offered choice regarding (4) choosing allopurinol vs. febuxostat as the first ULT (16%) and (5) taking daily ULT long-term vs. intermittently (15%). Rheumatologists perceived that a large proportion of patients were often or sometimes unsure of the best choice for these five decisions, 34%, 76%, 76%, 52%, and 54%, respectively. Similar proportions of rheumatologists felt that patients were uninformed about both medication benefits and risks, unclear about the personal importance of the benefits and risks, and unsupported in decision-making. For the five decisions respectively, rheumatologists supported SDM with patients in 76%, 56%, 58%, 27%, and 25%. The majority of VA rheumatologists incorporated SDM in several gout treatment decisions. Rheumatologists also recognized that patients need better support to participate in SDM in gout.Key Points:• Rheumatologists offered shared decision-making to gout patients for 3 key treatment decisions.• Rheumatologists perceived that many patients were unsure of the best choice for these decisions.• Rheumatologists felt that patients were uninformed about medication benefits/risks and unsupported in decision-making.
AB - To assess rheumatologists’ views and practices related to shared decision-making (SDM) in gout treatment. We performed a cross-sectional electronic survey of rheumatologists at U.S. Veterans Affairs (VA) medical centers, assessing views and practices related to SDM in gout. Of the 154 VA rheumatology providers eligible, 90 responded (response rate, 58%). Fifty-eight percent were female, the mean age was 51 years (standard deviation, 9.6), 42% had > 20 years of experience in medical practice. Rheumatologists reported routinely offering a choice to their patients for (1) starting urate-lowering therapy (ULT) for gout vs. doing nothing (70%); (2) choosing NSAIDs, corticosteroids, or colchicine for the treatment of acute flares (67%); and (3) choosing NSAIDs, corticosteroids, or colchicine for anti-inflammatory prophylaxis when starting ULT (51%). Very few rheumatologists offered choice regarding (4) choosing allopurinol vs. febuxostat as the first ULT (16%) and (5) taking daily ULT long-term vs. intermittently (15%). Rheumatologists perceived that a large proportion of patients were often or sometimes unsure of the best choice for these five decisions, 34%, 76%, 76%, 52%, and 54%, respectively. Similar proportions of rheumatologists felt that patients were uninformed about both medication benefits and risks, unclear about the personal importance of the benefits and risks, and unsupported in decision-making. For the five decisions respectively, rheumatologists supported SDM with patients in 76%, 56%, 58%, 27%, and 25%. The majority of VA rheumatologists incorporated SDM in several gout treatment decisions. Rheumatologists also recognized that patients need better support to participate in SDM in gout.Key Points:• Rheumatologists offered shared decision-making to gout patients for 3 key treatment decisions.• Rheumatologists perceived that many patients were unsure of the best choice for these decisions.• Rheumatologists felt that patients were uninformed about medication benefits/risks and unsupported in decision-making.
KW - Allopurinol
KW - Colchicine
KW - Febuxostat
KW - Gout
KW - Management
KW - NSAIDs
KW - Rheumatologists
KW - Shared decision-making
KW - Survey
KW - Urate-lowering therapy
UR - http://www.scopus.com/inward/record.url?scp=85091727736&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091727736&partnerID=8YFLogxK
U2 - 10.1007/s10067-020-05421-9
DO - 10.1007/s10067-020-05421-9
M3 - Article
C2 - 32997317
AN - SCOPUS:85091727736
SN - 0770-3198
VL - 40
SP - 693
EP - 700
JO - Clinical Rheumatology
JF - Clinical Rheumatology
IS - 2
ER -