Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The Nurse's Role in Treatment and Management of Patients with Rheumatoid Arthritis: A Delphi-Based Recommendation on Patient Unmet Needs.

Cottrell2,  Jane E. D., Jonas1,  Monique, Bulinckx3,  Leeanna M.

Charité University Hospital, Berlin, Germany
Mount Sinai Hospital, Toronto, ON, Canada
PerCuro Clinical Research Ltd, Victoria, BC, Canada


Nurses serve many critical roles in the management and treatment of patients with rheumatoid arthritis (RA), including educating and counseling the patient and liaising between the patient and rheumatologist. Examining how these roles differ among practices can help clarify areas in which nurses can optimize patient outcomes. The objective of this Delphi project was to assess the role of rheumatology nurses in addressing the unmet treatment and management needs of the RA patient


A modified Delphi method with two rounds of questionnaires was followed by an in-person meeting to explore issues on which consensus had not been reached. A steering committee of 3 nurses developed and refined the questionnaires. An international group of 12 nurses with extensive experience (clinical or research) with patients receiving biologic therapy for moderate to severe RA served as panelists and completed the questionnaires. Prior to the meeting, all responses were anonymous and confidential. Focal topic areas included the nurse's roles as caregiver, provider of information, and assessor of disease status and treatment outcomes. Special attention was paid to understanding patient physical and emotional needs.


In most European and Canadian practices/clinics, nurses spend substantially more time with the patient than the physician. In their interactions with patients, nurses initiate discussions about personal well-being and disease impact on quality of life—topics not always addressed by physicians due to time constraints or comfort level with these issues. Patients are more likely to discuss emotional and social issues related to their diagnosis with a nurse than a doctor and tend to expect the nurse to provide disease and treatment education to them and their families. The panelists agreed that it is critical to customize this information for each patient rather than provide written materials with no verbal explanation. The nurse is in a unique position to judge what level of support or education a patient may need at any given time. Although the benefits of support networks and peer-to-peer interactions were recognized, such interactions need not be limited to structured groups. While all panelists agreed that the doctor is more likely to recommend a particular therapy, the nurse has a critical role in educating the patient on efficacy, potential side effects, method and frequency of administration, product storage, and, if applicable, comfort with self-injection, including demonstrating proper device technique. Additionally, the nurse determines the patient's readiness for and understanding of the treatment, monitors safety and progress, and coordinates care within a multi-disciplinary setting.


The nurse's role in the management and treatment of patients with RA is complex and diverse, yet vitally important to optimal care. Although this Delphi initiative included a small group of nurses, it is clear that information shared across clinics and countries is both useful and practical in terms of improving patient care.

To cite this abstract, please use the following information:
Cottrell, Jane E. D., Jonas, Monique, Bulinckx, Leeanna M.; The Nurse's Role in Treatment and Management of Patients with Rheumatoid Arthritis: A Delphi-Based Recommendation on Patient Unmet Needs. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2279
DOI: 10.1002/art.30042

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