A decision tool to improve the quality of care in rheumatoid arthritis

Arthritis Care & Research , 04/18/2012

Fraenkel L et al. – A tool designed to effectively communicate the risks and benefits associated with biologic therapy increased knowledge, patient willingness to escalate care, and the likelihood of making an informed choice. The results of this study support the need for a clinical trial to examine the impact of the tool in clinical practice.


  • The authors developed a balanced, web–based, decision support tool. Options, values and probabilistic information were described using theoretically supported formulations.
  • They conducted a pre–post test study to assess preliminary evidence of the tool's efficacy in improving knowledge related to biologics, clarity of values, willingness to take a biologic and informed choice.


  • They interviewed 104 subjects; mean age = 62; 84% female, 86% White; median duration of RA = 13 years.
  • Knowledge (coded on a 0 to 20 scale) and willingness to take a biologic (coded on a 0 to 10 scale) significantly increased after viewing the tool (mean differences = 3.1 and 1.4 respectively, both p < 0.0001).
  • Perceived knowledge and value clarity (coded on 0 to 100 scales) also significantly improved (mean differences 20.4 and 20.7 respectively, both p<0.001).
  • The proportion of subjects making an informed, value–concordant choice increased substantially from 35% to 64%.

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