Patients' considerations in the decision-making process of initiating disease-modifying anti-rheumatic drugs

Objectives To explore what considerations patients have when deciding about disease-modifying anti-rheumatic drugs (DMARDs) and what information patients need to participate in the decision-making process. Methods In-depth face-to-face interviews were conducted with 32 inflammatory arthritis patients who recently consulted their rheumatologist and discussed initiating DMARDs. Results Beliefs in the necessity of DMARDs, either for relief of symptoms or prevention of future joint damage, were reasons to initiate DMARDs. Furthermore, trust in the rheumatologist and the healthcare system was important in this respect. Patients expressed many concerns about initiating DMARDS. These related to the perceived aggressive and harmful nature of DMARDs, potential (or unknown) side effects, influence on fertility and pregnancy, combination with other medicines, time to benefit and manner of administration. Participants also worried about the future: about long term medication use and the feeling of dependency, and, -if this medicine proved to be ineffective-, about the risks of future treatments and running out of options. To decrease this uncertainty, participants wanted to be informed about multiple treatment options, both current and future. They did not only want clinical information, but also information on how the medications could affect their daily lives. Conclusion Health education should inform patients about multiple treatment options, for the current time being as well as for the future. It should enable patients to compare treatments with regards to both clinical aspects as well as possible consequences for their daily lives. This article is protected by copyright. All rights reserved