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Patients’ Attitudes and Experiences of Disease‐Modifying Antirheumatic Drugs in Rheumatoid Arthritis and Spondyloarthritis: A Qualitative Synthesis
Author(s) -
Kelly Ayano,
Tymms Kathleen,
Tunnicliffe David J.,
Sumpton Daniel,
Perera Chandima,
Fallon Kieran,
Craig Jonathan C.,
Abhayaratna Walter,
Tong Allison
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23329
Subject(s) - medicine , rheumatoid arthritis , cinahl , thematic analysis , medline , disease , qualitative research , family medicine , physical therapy , intensive care medicine , nursing , psychological intervention , social science , sociology , political science , law
Objective Nonadherence to disease‐modifying antirheumatic drugs ( DMARDS ) in rheumatoid arthritis ( RA ) and spondyloarthritis (SpA) results in increased disease activity and symptoms and poorer quality of life. We aimed to describe patients’ attitudes and experiences of DMARD s in RA and SpA to inform strategies to improve medication adherence. Methods Databases ( MEDLINE , Embase, Psyc INFO , and CINAHL ) were searched to January 2016. Thematic synthesis was used to analyze the findings. Results From 56 studies involving 1,383 adult patients ( RA [n = 1,149], SpA [n = 191], not specified [n = 43]), we identified 6 themes (with subthemes): intensifying disease identity (severity of sudden pharmacotherapy, signifying deteriorating health, daunting lifelong therapy), distressing uncertainties and consequences (poisoning the body, doubting efficacy, conflicting and confusing advice, prognostic uncertainty with changing treatment regimens), powerful social influences (swayed by others’ experiences, partnering with physicians, maintaining roles, confidence in comprehensive and ongoing care, valuing peer support), privilege and right of access to biologic agents (expensive medications must be better, right to receive a biologic agent, fearing dispossession), maintaining control (complete ownership of decision, taking extreme risks, minimizing lifestyle intrusion), and negotiating treatment expectations (miraculous recovery, mediocre benefit, reaching the end of the line). Conclusion Patients perceive DMARD s as strong medications with alarming side effects that intensify their disease identity. Trust and confidence in medical care, positive experiences with DMARDS among other patients, and an expectation that medications will help maintain participation in life can motivate patients to use DMARD s. Creating a supportive environment for patients to voice their concerns may improve treatment satisfaction, adherence, and health outcomes.