Rheumatoid Arthritis Patients’ Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens

Yomei Shaw, Ilinca D. Metes, Kaleb D Michaud, Julie M. Donohue, Mark S. Roberts, Marc C. Levesque, Judy C. Chang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients’ feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. Methods: A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. Results: In addition to feelings about the necessity and dangers of medications, patients’ feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients’ motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. Conclusion: Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients’ feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients’ feelings throughout the treatment decision-making process.

Original languageEnglish (US)
Pages (from-to)533-541
Number of pages9
JournalArthritis Care and Research
Volume70
Issue number4
DOIs
StatePublished - Apr 2018

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Antirheumatic Agents
Motivation
Rheumatoid Arthritis
Emotions
Therapeutics
Fear
Decision Making
Patient Compliance
Cost-Benefit Analysis
Interviews
Health

ASJC Scopus subject areas

  • Rheumatology

Cite this

Rheumatoid Arthritis Patients’ Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. / Shaw, Yomei; Metes, Ilinca D.; Michaud, Kaleb D; Donohue, Julie M.; Roberts, Mark S.; Levesque, Marc C.; Chang, Judy C.

In: Arthritis Care and Research, Vol. 70, No. 4, 04.2018, p. 533-541.

Research output: Contribution to journalArticle

Shaw, Yomei ; Metes, Ilinca D. ; Michaud, Kaleb D ; Donohue, Julie M. ; Roberts, Mark S. ; Levesque, Marc C. ; Chang, Judy C. / Rheumatoid Arthritis Patients’ Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. In: Arthritis Care and Research. 2018 ; Vol. 70, No. 4. pp. 533-541.
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abstract = "Objective: Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients’ feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. Methods: A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. Results: In addition to feelings about the necessity and dangers of medications, patients’ feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients’ motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. Conclusion: Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients’ feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients’ feelings throughout the treatment decision-making process.",
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