224. HOW MUCH IS TOO MUCH? RHEUMATOLOGISTS’ VIEWS ON DISCUSSING METHOTREXATE FOR THE TREATMENT OF RHEUMATOID ARTHRITIS WITH PATIENTS

Abstract

Background: Rheumatologists are the primary prescribers of MTX for the treatment of rheumatoid arthritis (RA) in the United Kingdom; however their views about MTX are largely unknown. In a previous qualitative study rheumatologists highlighted a number of factors that contributed to their ability to discuss and commence MTX, which included how cognitively prepared patients were to discuss treatments. The aim of this study was to further explore these themes and investigate how rheumatologists inform patients during clinical consultations. Methods: This is the second phase of a sequential exploratory mixed methodology design. An online survey was designed to investigate UK rheumatologists' views about MTX, and refined based on a qualitative study with rheumatologists in the UK. The survey asked rheumatologists to describe their clinic (multidisciplinary staff, drug education, time spent with patients) and their typical MTX regimen. Rheumatologists were presented with a series of MTX and RA related issues and asked how important it was for them to discuss each one with the patient during a consultation to commence MTX (5=Always to 1 = never). They were also asked “If you do not always discuss these issues can you identify the reasons why?” and provided with a predefined response set and free text option to select from. Results: 96 rheumatologists with 15±7 years of clinical experience based in University Teaching Hospitals (41%), District General Hospitals (46%) or community settings (6%) participated. Rheumatologists reported they always or often discussed 10 (IQR 8-11) key pieces of information during a consultation to commence MTX. These included; benefits of MTX (98%), common side effects (94%), blood monitoring (91%), RA prognosis (90%), dosing regimen (89%), alcohol use (89%), serious side effects (88%), patient concerns (88%), synovitis (72%) and adherence (72%). The most frequently reported reason for not discussing these issues with the patient were that the nurse would fulfil this role (56%), followed by not enough time (46%), and not wanting to overload the patient with information (46%), some rheumatologists (18%) reported they do not discuss some issues because patients would not commence MTX if they knew everything. Conclusion: Rheumatologists are conveying a lot of information to patients during commencement consultations, and rheumatologists identified information overload as a reason not to discuss MTX. These results support the findings of the preceding qualitative study, and suggest there is a reliance of rheumatologists on nurses to support overloaded patients; therefore nurses' views on their role during MTX commencement need to be investigated. Reducing the amount of information during clinical consultations may benefit some patients and this should be explored.