Guidelines for rheumatoid arthritis (RA) formulated by a panel of patients had most of the same recommendations as those developed by a panel of physicians, researchers report.
Clinical practice guidelines (CPGs) are an effective method of reducing variability in care and ensuring that providers are using the most evidence-based practices. However, the development of CPGs can often force tradeoffs between potential benefits, possible harms, and burden of treatment, which involve subjective judgments.
A study published in the journal Arthritis Care & Research evaluated the differences between how patients and physicians value aspects of treatment in forming evidence-based guidelines.
For the study, researchers formed a panel of 10 volunteers with RA (3 men and 7 women between the ages of 29 and 56 years) and paired them with 2 staff members from the American College of Rheumatology with expertise in CPG development, and a physician facilitator. The panel was then asked to apply the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to 18 questions for which there was evidence warranting moderate or high confidence.
After recommendations by the patients were complete, a different panel of 9 physicians and 2 patient representatives were asked to do the same.
The patient panel only developed recommendations for 16 of the 18 questions, concluding that there was insufficient information to support a recommendation for the other 2 questions. For 13 of the 16 questions, the patient panel recommended the same course of action as what was advised by the physician panel.
The sources of disagreement between the panels were mainly differences in perceived benefit. The patient panel advised triple therapy due to a lack of significant added toxicity, whereas the physician panel voted against it due to the knowledge that the benefits of triple therapy would likely not be significant after 2 years. In addition, the physicians advised against using tofacitinib over methotrexate, whereas patients support the use of tofacitinib because of its incremental benefits and lower risk of gastrointestinal side effects.
According to the authors, based on the insights gained from their study, the American College of Rheumatology is currently deliberating how to modify their procedures for developing clinical guidelines in order to better incorporate patient input.
