Patient-Centered Shared Decision-Making in Rheumatic Diseases

Patient information at the time of SDM implementation was retrospectively obtained from the medical records. The surveyed items were sex, age (years), age (<65 years/≥65 years), RA, multiple rheumatic diseases, disease duration (years), disease duration (<10/≥10 years), disease activity (active/inactive), number of drugs used (number), number of drugs used (<5/≥5), history of allergy or side effects, history of allergy or side effects due to biologics or Janus kinase inhibitor, biologics, or Janus kinase inhibitor usage history before SDM. Age was classified into two categories according to the World Health Organization (WHO). Disease duration was classified into two categories based on a previous report on RA (12 (link)). Disease activity was classified into two categories; patients with RA were categorized as inactive if they exhibited low disease activity or remission based on their DAS28-CRP value and as active if they exhibited moderate or high disease activity. Those with other rheumatic diseases were classified as inactive if clinically judged by a physician to be in remission or have low disease activity and as active if they were otherwise judged to have moderate or higher-intensity symptoms. The number of drugs used was classified into two categories based on a previous report on polypharmacy (13 (link)).
The influential values of patients regarding drug treatment were compiled from subjective data describing values chosen by patients during conversations between pharmacists and patients during SDM implementation. The values compiled were multiple selected and single selected from the five values: effectiveness, safety, economic, daily life (drug treatment burden on life), and others (such as route of administration, type of device).
The continuance rate of treatment 6 months after SDM and disease status (improvement, aggravation, and no change) were evaluated, with reasons including inadequate effectiveness, side effects, economic issues, daily life issues, and other issues among patients.
The details of the drug treatment changes selected after the implementation of SDM were tabulated. The results included changing the drugs, tight control, no change, drug use cessation, increased dosage, change in the route of administration, addition of an oral drug, oral drug cessation, reduced dosage, changes in oral drug, and shortening of the interval between doses.
Because SDM was performed in the usual clinical setting, the pharmacists were not blinded to the outcomes, such as the continuance rate of treatment.