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Ethnographic Observational Study of the Biologic Initiation Conversation Between Rheumatologists and Biologic‐Naive Rheumatoid Arthritis Patients
Author(s) -
Kottak Nicholas,
Tesser John,
Leibowitz Evan,
Rosenberg Melissa,
Parenti Dennis,
DeHoratius Raphael
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.23527
Subject(s) - medicine , conversation , rheumatoid arthritis , observational study , physical therapy , family medicine , psychology , communication
Objective This ethnographic market research study investigated the biologic initiation conversation between rheumatologists and biologic‐naive patients with rheumatoid arthritis to assess how therapy options, particularly mode of administration, were discussed. Methods Consenting rheumatologists (n = 16) and patients (n = 48) were videotaped during medical visits and interviewed by a trained ethnographer. The content, structure, and timing of conversations regarding biologic initiation were analyzed. Results The mean duration of physician‐patient visits was approximately 15 minutes; biologic therapies were discussed for a mean of 5.6 minutes. Subcutaneous ( SC ) and intravenous ( IV ) therapy options were mentioned in 45 and 35 visits, respectively, out of a total of 48 visits. All patients had some familiarity with SC administration, but nearly half of patients (22 of 48) were unfamiliar with IV therapy going into the visit. IV administration was not defined or described by rheumatologists in 77% of visits (27 of 35) mentioning IV therapy. Thus, 19 of 22 patients who were initially unfamiliar with IV therapy remained unfamiliar after the visit. Disparities in physician‐patient perceptions were revealed, as all rheumatologists (16 of 16) believed IV therapy would be less convenient than SC therapy for patients, while 46% of patients (22 of 48) felt this way. In post‐visit interviews, some patients seemed confused and overwhelmed, particularly when presented with many treatment choices in a visit. Some patients stated they would benefit from visual aids or summary sheets of key points. Conclusion This study revealed significant educational opportunities to improve the biologic initiation conversation and indicated a disparity between patients’ and rheumatologists’ perception of IV therapy.