RESULTS OF A PILOT STUDY OF A TAILORED SYMPTOM ASSESSMENT TOOL TO ENHANCE PATIENT-CENTERED CARE IN RHEUMATOID ARTHRITIS: CHOICE RA

   Purpose: Discordance in the assessment of rheumatoid arthritis (RA) disease activity has been reported in 30% of patient-clinician dyads, with discordance higher for those with depressed mood. Our objective was to pilot-test a tablet-based, patient-reported symptom tool to improve communication around preference-sensitive symptoms among diverse RA patients.

   Methods: We conducted a pilot study to test the acceptability, feasibility and efficacy of CHOICE RA, a tablet-based, preference-sensitive symptom reporting tool.  58 symptoms derived from the literature and patient and rheumatologist focus groups populate the tool across 4 categories:  1) Physical symptoms, 2) Function; 3) Feelings and relationships, 4) Joint pain and swelling. Patients select and prioritize symptoms based on their perceived need for care. Eligibility was: age ≥18, Spanish or English speaking, and diagnosis of RA.  Participants from two university-affiliated rheumatology clinics were enrolled into one of two study arms. All patients completed CHOICE RA before their appointment, and later a post-visit survey. In Arm 2, clinicians received a summary of patients’ choices but not in Arm 1. The primary outcome was congruence between mean total patient-reported symptoms and those discussed in the visit. Congruence for high priority symptoms stratified by language was investigated. Acceptability and satisfaction were measured in clinicians and patients.  We compared means using t-tests and proportion of high priority symptoms discussed using Fischer’s exact tests.

   Results:  45 patients enrolled (Arm 1: 24, Arm 2: 21), 91% were female; mean age 53±13, 56% Spanish-speaking, 42% had limited health literacy. There were no statistically significant differences in congruence scores by study arm. However, in subgroup analyses, a significantly greater number of high-priority mood symptoms were discussed in arm 2 (55%) compared to Arm 1 (0%) among Spanish-speakers (p=0.04). Majority (≥ 90%) found the tool acceptable based on ease of use and usefulness.  98% reported the tool facilitated communication with their doctor.

   Conclusion: CHOICE RA was highly acceptable to Spanish and English-speaking RA patients and clinicians, and helped patients communicate high priority symptoms to their clinician. While it did not increase congruity in total symptoms listed vs. discussed overall, it increased discussion of mood symptoms highly prevalent in this vulnerable group with communication barriers. Results from this promising pilot study should lead to a larger, multi-site trial to evaluate its impact on a broader population.