Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

A Decision Aid for Rheumatoid Arthritis Patients Considering Methotrexate Therapy

Martin1,  Richard W., Gallagher2,  Patience J., Eggebeen1,  Aaron T., Head1,  Andrew J.

Michigan State University, Grand Rapids, MI
Calvin College, Grand Rapids, MI


Patient decision aids (PtDA) are tools that medical providers use as a supplement to clinical discussion. PtDAs contain information with choices and outcome probabilities, help patients clarify their values, and provide structured guidance about deliberation. This study sought to develop and pilot test an inexpensive PtDA that could be used during and following a clinical encounter by rheumatoid arthritis (RA) patients considering methotrexate (MTX) therapy.


The PtDA was developed following International Patient Decision Aid Standards Consortium (IPDAS) criteria1. Outcome probabilities were identified from the published literature. A preliminary PtDA was pre-tested in 5 RA patients and 10 rheumatology professionals. After revision, formal pilot testing was conducted in RA patients who had made the decision to start MTX in the past 2 years. Evaluation included visual screening, health literacy screening, time to complete the PtDA, formative and summative questionnaires, and extended structured interviews to illicit feedback to improve the usability of the materials.


The decision aid was developed using plain language (SMOG score of 9.9) and expressing outcome probabilities simultaneously in narrative, natural frequencies, and pictographs. Outcome values clarification and preferred decision making role were elicited with social matching exercises. Deliberation was guided with a modified balance and leaning scale. Of the 17 participants, 76.5% were female, 94.1% were white, 17.6% attained less than high school graduation and 23.5% displayed low or marginal health literacy. Mean completion time was 12.7 minutes (SD 4.0). Persons with lower levels of confidence in (p<.01) and satisfaction with (p<.02) their previous decision to take MTX took significantly more time to work through the PtDA. Responses about the acceptability, clarity and usefulness of the PtDA were significantly more positive when compared to the neutral value of 3 (p<.02) using a one sample t-test for each of the 15 formative evaluation questions. Pre-post PtDA testing of MTX-related knowledge disclosed a significantly increased score from 71.5 to 82.9% correct (p<.01), which translates into an effect size of 0.35 for the intervention. Qualitative responses from structured interviews revealed patients felt the PtDA was enjoyable to read, the contents were logical and understandable, and the length was about right. Appraisal with the IPDAS instrument2 disclosed a quality score of 74 (0–100) which is in the range of existing benchmark decision aids.


Pilot testing suggests that the PtDA is acceptable to patients and effectively informs them of the risks and benefits of MTX. This PtDA could be used as an adjunct to a rheumatology office encounter to encourage shared decision making and increase patients' choice of preference-based care.


1British Medical Journal. 2006;333:417.

2PLoS ONE 4(3):e4705.doi:10.1371/journal.pone.0004705.

To cite this abstract, please use the following information:
Martin, Richard W., Gallagher, Patience J., Eggebeen, Aaron T., Head, Andrew J.; A Decision Aid for Rheumatoid Arthritis Patients Considering Methotrexate Therapy [abstract]. Arthritis Rheum 2009;60 Suppl 10 :324
DOI: 10.1002/art.25407

Abstract Supplement

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