Treatment choices, preferences and decision-making by patients with rheumatoid arthritis


  • Frances Chilton RGN, DipN, BSc (Hons), MSc,

    Corresponding author
    1. Rheumatology Department, South Warwickshire NHS Trust Hospital, Warwick, UK
    • Clinical Nurse Specialist, Rheumatology Department, South Warwickshire NHS Trust, Lakin Rd, Warwick, CV34 5BW, UK. Fax: +44 (0)1926 600083
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  • Raymond A. Collett BA, PhD, CBiol

    1. Institute of Health, Social Care & Psychology, University of Worcester, Worcester, UK
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Objectives: To explore rheumatoid arthritis (RA) patient treatment preferences, their decision-making and the treatment choices they would make when faced with three anti-tumour necrosis factor-α (TNF-α) therapy options.

Methods: Two methods of enquiry were used: postal questionnaire and one-to-one interviews. RA patients not taking anti-TNF-α medications were asked to complete a questionnaire after reading a written scenario, which involved choosing and identifying factors that influenced their treatment choice from three anti-TNF-α therapies: etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). Patients who had tried more than one anti-TNF-α medication were asked at one-to-one interviews for their treatment preferences and how their current treatment had been decided.

Results: Both interviewees and questionnaire respondents chose adalimumab as their preferred treatment. Interviewees identified lack of control, convenience and technical issues as influencing treatment choice. Questionnaire respondents were less likely than interviewees to want to participate in making decisions about the selection of anti-TNF-α therapy. There were few gender differences. Patients younger than 61 years old were more confident about self-administering treatment, and preferred subcutaneous (sc) over intravenous (iv) medication, as this reduced regular hospital attendance. Older patients preferred health care staff to administer treatment and more readily identified ‘contact with other patients/meeting others’ and ‘staff availability if problems arise’ as factors influencing choice.

Conclusions: RA patients demonstrate a clear treatment preference. Different factors influence patients who choose sc compared with iv medications. Many RA patients either wished to share in treatment decisions or relinquish responsibility to the health professional when choosing anti-TNF-α therapy. Patients require reassurance and continuing dialogue with clinicians to manage their condition optimally. Copyright © 2007 John Wiley & Sons, Ltd.