A Mixed-Methods Exploration: Expectations of Medication Reduction in Patients with Rheumatoid Arthritis

Guidelines for treatment of patients with rheumatoid arthritis (RA) recommend medication reduction, specifically DMARD reduction, for patients reaching sustained remission. However, patients with RA are frequently concerned about potential reduction outcomes and therefore hesitant to reduce their medication. Given the impact of expectations on treatment outcomes, this project intended to systematically examine treatment outcome expectations of medication reduction among patients with RA, factors underlying these expectations, and the impact of these expectations on patients’ willingness to reduce their medication. By considering patients’ reduction-related needs and preferences, insights from this project aim to inform the design of future expectation management training to facilitate medication reduction in patients with RA. Using a convergent mixed-methods design, quantitative and qualitative data was collected in semi-structured interviews with 18 patients diagnosed with RA. Open...Show moreGuidelines for treatment of patients with rheumatoid arthritis (RA) recommend medication reduction, specifically DMARD reduction, for patients reaching sustained remission. However, patients with RA are frequently concerned about potential reduction outcomes and therefore hesitant to reduce their medication. Given the impact of expectations on treatment outcomes, this project intended to systematically examine treatment outcome expectations of medication reduction among patients with RA, factors underlying these expectations, and the impact of these expectations on patients’ willingness to reduce their medication. By considering patients’ reduction-related needs and preferences, insights from this project aim to inform the design of future expectation management training to facilitate medication reduction in patients with RA. Using a convergent mixed-methods design, quantitative and qualitative data was collected in semi-structured interviews with 18 patients diagnosed with RA. Open-ended questions were interspersed with NRS items to measure quantitative predictors, including past successful and unsuccessful experiences with medication reduction, trust in the healthcare provider, confidence in personal medication reduction success, medication burden, perceived disease control, fear of flare, and perceived dependence on medication. Single (p < .10) and stepwise regression analyses (p < .25) were used for the exploratory quantitative part and inductive thematic analysis was used for the qualitative part. Integration of qualitative and quantitative results, particularly past experiences with medication reduction and confidence in personal reduction success appeared to underlie both positive and negative expectations of medication reduction. Fear of flare seemed to be relevant for negative reduction expectations. Participants appeared more willing to reduce medication with increased positive expectations and decreased negative expectations. Relevant needs related to reduction included accessible healthcare and support, credible information, specific reduction plans and instructions, and more personalized treatment approaches. Preferences for a future expectation management training were reflective of those needs. To facilitate medication reduction in patients with RA, it is recommended that future healthcare interventions, such as expectation management trainings, address past experiences, increase patients’ confidence in personal medication reduction success, reduce fear of flare, and offer accessible support, information, and personalized reduction plans. Larger-scale studies are needed to validate these findings.Show less

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A Mixed-Methods Exploration: Expectations of Medication Reduction in Patients with Rheumatoid Arthritis