Grant: Project Grant

Over the past 20+ years, better treatments have improved the lives of people living with rheumatoid arthritis. About two or three out of every ten people with rheumatoid arthritis require advanced therapy (biologic or targeted synthetic disease-modifying antirheumatic drugs, known as DMARDs). These medications are very effective but have some risks (like infections) and are expensive for health systems. Doses of these medications can be safely reduced in many patients, but reducing is not right for everyone. Some people would never want to reduce their medication, while others are very keen to try. This makes the decision ideally suited to shared decision-making, a process where patients and health care providers make decisions together using research and considering a person's values and preferences. National guidelines for rheumatoid arthritis now recommend that tapering is discussed with patients, but these discussions are uncommon. To support people in these decisions, we developed a decision aid that explains the risks and benefits of tapering to people. In a pilot study, we found that the decision aid helped trigger discussions around tapering, leading to an increase of people who chose to taper their medication after discussion with their rheumatologist. In this study we will evaluate the impact of this approach on a broader scale. People with rheumatoid arthritis who are taking these medications and are doing well will be assigned to receive a decision aid ahead of their appointment while others will not receive the decision aid. We will evaluate the impact of the decision aid on peoples' choices and follow people over the next year. We believe that this simple, low-cost intervention has the potential to make healthcare better for people with rheumatoid arthritis while also saving money for the health system.