UBC Theses and Dissertations
Preventing rheumatoid arthritis : understanding factors that influence decisions to take preventative treatments for rheumatoid arthritis Spooner, Luke
Introduction: Currently, there are ongoing clinical trials for preventative treatments that aim to prevent and minimize the progression to RA in high risk individuals. However, preferences that drive people’s decision making in the context of a preventative treatment are unknown. With these clinical trials reporting their results within the next 2 years, this thesis aims to understand preferences of those who are at high risk of RA around preventative treatment and guide how these preferences can be best implemented in preventative treatment programs. Objectives: 1) To identify important attributes for uptake of a preventative treatment program for those who are at high risk of RA, 2) To identify the value that is placed on these attributes through a discrete choice experiment (DCE), and 3) To predict the potential uptake of a preventative treatment options in those who are at high risk of RA Methods To determine the attributes that were important for the uptake of a preventative treatment program for those who are at high risk of RA, individuals with RA, first-degree relatives and rheumatologists were interviewed. These interviews were analyzed through a Framework Method. A DCE provided insight into whether those who are at high risk of RA would be willing to take preventative treatment. Results: The qualitative Framework analysis of patient, first-degree relative, and rheumatologist focus groups yielded five different attributes to be included in a DCE. Including the five treatment related attributes in the DCE demonstrated that first-degree relatives and RA patients preferred preventative treatments that had high risk reduction of RA, were orally administered, minor reversible side effects, moderate certainty in estimates, and were preferred by the health care provider. Predicted uptake of preventative treatments ranged from 51% to 92%, with oral methotrexate having the highest and infusion rituximab having the lowest. Conclusion: This thesis provides understanding around preferences, and subsequent trade-offs that an at risk individual might make when considering preventative treatment for RA. Through these trade-offs, the most important attributes of a preventative treatment program have been identified, and the likely uptake of potential preventative treatments have been estimated.
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