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THU0589 Patient-perceived coping was associated with patient-perceived quality of [...]

Gossec, L., Desthieux, C., Cantagrel, A., Soubrier, M., Berthelot, J.M., Joubert, J.M., Combe, B., Czarlewski, W., Wendling, D., Dernis, E., Grange, L., Beauvais, C., Perdriger, A., Nataf, H., Dougados, M., Servy, H. (June 2017)

Background There has been growing emphasis on the importance of shared decision-making in rheumatoid arthritis (RA).1,2 Patient-physician (pt-phy) shared decision-making necessitates open and thorough discussions and good interactions.

Objectives This analysis explored pt-perceived quality levels of pt-phy interactions and characteristics of pts when these interactions are described as very good by pts.

Methods CarNET (NCT02200068) was a French, 12-month, multicentre randomised controlled trial to assess access to an e-health platform (Sanoïa) allowing self-assessment of disease.1,2 This was a post-hoc analysis, using baseline data only. Pts had confirmed RA and were enrolled by their treating rheumatologist. Pt-perceived pt-phy interactions were assessed through the pt-reported questionnaire Perceived Efficacy in Patient-Physician Interactions (PEPPI-5)3 which consists of 5 items, each starting with “How confident are you in your ability to ...” (eg. “... know what questions to ask a doctor?”). Pts rated each item on an 11-point scale; 0=not at all confident, 10=very confident. Total PEPPI-5 scores range from 0–50; higher scores represent higher perceived self-efficacy in pt-phy interactions. Factors associated with a higher PEPPI-5 (ie. >median) were analysed by univariate and multivariate logistic regression (factors included pt demographics, phy demographics, disease characteristics and activity including pt-perceived coping [scored 0–10 in the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire; lower scores indicate better coping]).

Results Of 320 RA pts (159 vs 161; Sanoïa vs usual care), mean±SD age was 57.0±12.7 years, disease duration was 14.6±11.1 years and 253 (79.1%) were female. Mean DAS28 was 2.7±1.2, 54.1% were in DAS28 remission (<2.6); 216 (67.5%) were taking a biologic; 21.9% had previous therapeutic education sessions; 15.3% were members of pt associations; and 51.9% had followed university-level studies. The mean±SD PEPPI-5 score was 39.2±7.8 and the median was 40. In univariate analyses, associations with p<0.05 were observed between pt-perceived coping (p=0.0008), erosive disease (p=0.03) and DAS28 remission (p=0.05) and a high PEPPI-5; associations with p<0.2 were observed for older age (p=0.07) and HAQ-DI≤0.5 (p=0.12). In multivariate analyses, the only factor associated with high PEPPI-5 was pt-perceived coping (odds ratio [95% CI]=0.85 [0.76–0.96]; p=0.007).

Conclusions Among RA pts whose disease was well controlled, pt-perceived pt-phy interactions were good. Pt-perceived coping was associated with better pt-perceived pt-phy interactions, indicating that perhaps pts who felt in control were more at ease with their phy, or vice-versa. The data did not allow us to attribute causality. These elements are important in the shared decision-making process.

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