Individualized treatment, where the right patient receives the right dose of the right drug at the right time, could be interpreted as a purely medical task. After genetic and other tests on the patient, the doctor assesses, from a medical point of view, which drug for the disease and which dose should work most effectively and most safely for the patient in question.
Individualization can also be interpreted to include the patient’s perceptions of the treatment, the patient’s own preferences. Rheumatoid arthritis is a disease with many different symptoms. Several drugs are available that have different effects on different symptoms, as well as different side effects. In addition, the drugs are administered in different ways and at different intervals. Of course, all of these drug attributes affect the patients’ daily lives differently. A drug may reduce pain effectively, but cause depression, and so on. In individualized treatment of rheumatoid arthritis, there are therefore good reasons to ask patients what they consider to be important drug attributes and what they want their treatment to aim for.
In a study in Clinical Rheumatology, Karin Schölin Byvall and five co-authors prepare for individualized treatment of rheumatoid arthritis from the patient’s perspective. Their hope is to facilitate not only joint decision-making with patients who have the disease, but also future quantitative studies of preferences in the patient group.
This is how the authors (very simplified) proceeded. A literature review was first performed to identify possible relevant drug attributes. Subsequently, patients in Sweden with rheumatoid arthritis ranked nine of these attributes. In a third step, some of the patients were interviewed in more detail about how they perceived the most important attributes.
In a final step, the interview results were structured in a framework with four particularly relevant drug attributes. The first two are about improved ability to function physically and psychosocially in everyday life. The latter two are about serious and mild side effects, respectively. In summary, the most important drug attributes, from the patients’ perspective, are about improved ability to function in everyday life and about acceptable side effects.
If you want to know more about the study, read the article: Functional capacity vs side effects: treatment attributes to consider when individualizing treatment for patients with rheumatoid arthritis.
The authors emphasize the importance of considering patients’ own treatment goals. Individualized treatment not only requires medical tests, but may also require studies of patient preferences.
Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.
Bywall, K.S., Esbensen, B.A., Lason, M. et al. Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis. Clin Rheumatol (2021). https://doi.org/10.1007/s10067-021-05961-8
In dialogue with patients