Exploring the expectations, needs and concerns of people with rheumatoid arthritis commencing Methotrexate

Logan, Sarah Jane

Abstract

Background
Methotrexate is recommended as initial disease modifying anti-rheumatic drug (DMARD) therapy to treat Rheumatoid Arthritis (RA). Rheumatology nurses provide information in DMARD counselling consultations to support people to take treatment safely. Despite receiving information, many people do not start or continue to take Methotrexate, resulting in worse outcomes and disability. It is unclear what information people require when starting Methotrexate, and how this should be provided. Understanding of this could inform service provision and practice.

Methods
A mixed methods systematic review (MMSR) was undertaken to identify the information needs of people with IA taking Methotrexate. The findings of the MMSR informed a semi-structured qualitative interview study to explore whether current methods of DMARD counselling met the expectations, experiences, needs and concerns of adults with RA when starting Methotrexate. Nineteen participants took part in interviews before and after DMARD counselling (n=8) or single interviews after DMARD counselling (n=11). Data was analysed using Reflexive Thematic Analysis and findings reviewed by stakeholders.

Results
The combined findings from the MMSR and qualitative study identified that people with RA have individual, multifaceted information needs and concerns about Methotrexate. The opportunity to speak to a nurse was valued, but many people experienced one-size-fits-all DMARD counselling. Despite receiving large amounts of information, unmet needs were frequently reported, with important practical and safety information being difficult to recall. In-person DMARD counselling was preferred by most, telephone consultations were acceptable, sometimes preferred due to personal circumstances. Stakeholders including a rheumatology clinical-academic rheumatologist, clinical and research nurses and a service manager reviewed study findings. Recommendations were made for person-centred DMARD counselling and development of accessible information strategies.

Conclusions
Current methods of DMARD counselling often do not meet the information needs of people commencing Methotrexate. A stratified, person-centred approach to DMARD counselling that offers people a choice regarding the timing and mode of consultation together with provision of needs-based information in a variety of accessible formats is recommended. Such an approach could resolve concerns whilst supporting information recall, thereby improving access and adherence to treatment, improving outcomes.

Citation

Logan, S. J. Exploring the expectations, needs and concerns of people with rheumatoid arthritis commencing Methotrexate. (Thesis). Keele University. Retrieved from https://keele-repository.worktribe.com/output/956315

• Thesis Type: Thesis
• Deposit Date: Oct 28, 2024
• Publicly Available Date: Oct 28, 2024
• Public URL: https://keele-repository.worktribe.com/output/956315
• Award Date: 2024-10