1. Self management decision support for individuals with inflammatory arthritis: A systematic review protocol of the efficacy of condition specific decision aids.
Patient-centred care in established rheumatoid arthritis
M.J.H. Voshaar MSc a 1 , I. Nota MSc a 1 , M.A.F.J. van de Laar MD, PhD a b  and B.J.F. van den Bemt PharmD, PhD c d ⁎
Best Practice & Research Clinical Rheumatology
M.J.H. Voshaar MSc a 1 , I. Nota MSc a 1 , M.A.F.J. van de Laar MD, PhD a b  and B.J.F. van den Bemt PharmD, PhD c d ⁎
Patient-centred care in established rheumatoid arthritis
M.J.H. Voshaar MSc a 1 , I. Nota MSc a 1 , M.A.F.J. van de Laar MD, PhD a b  and B.J.F. van den Bemt PharmD, PhD c d ⁎
Best Practice & Research Clinical Rheumatology
Patient-centred care in established rheumatoid arthritis
M.J.H. Voshaar MSc a 1 , I. Nota MSc a 1 , M.A.F.J. van de Laar MD, PhD a b  and B.J.F. van den Bemt PharmD, PhD c d ⁎
Best Practice & Research Clinical Rheumatology
Methods
Inclusion criteria
Types of participant:
Adult Individuals, diagnosed with inflammatory arthritis at any stage of disease. Parents of children and adolescents with Juvenile inflammatory arthritis.
Types of intervention
Studies may include decision aid tools for any aspect of arthritis self management ( pharmaceutical, behavioural or surgical) and may describe tools in any format. Comparator studies may include no decisional support, alternative decisional support ( ie anticipatory guidance) or standard non values based education.
The PDA may be used in any setting, ie primary care, tertiary care. The PDA may be used with any health professional in the health care team. The PDA may be used before or within consultation sessions.
Outcomes
This review will consider any outcomes that increase participants ability to make decisions and may include adherence ( where tools consider pharmacotherapy), confidence/ self efficacy in specific aspects self management and decisional conflict as a result of using the tool.
Types of studies
This review will include both RCT, Quasi experimental and cohort studies that describe the use of PDA
Exclusion
Tools for clinical decision making from a professional perspective will be excluded.
Appraisal tools
Papers selected for retrieval will have methodological quality assessed by two independent reviews using the JBI standardised critical appraisal tools relevant to the type of study. Application of the the International Patient Decision Aid Standards instrument (IPDASi) will be considered subject to approval.
Ms Judith Lowe1, Dr Matthew Stephenson2, Dr Elizabeth Hoon3
1 MClinSci candidate, The Joanna Briggs Institute, Faculty of Health Science, The University of Adelaide, SA 5005.
2 Research Fellow, The Joanna Briggs Institute, University of Adelaide, SA 5005.
3 Arthritis SA Florey Researcher, School of Population Health, University of Adelaide, SA 5005.
Background
Health care is changing from physician-centred care to patient-centred , in which the health professional and the patient together decide what the best care will be1. Patient decision aids (PDA) are one form of decisional support that may be used to guide shared care. These tools are not meant to replace practitioner consultation. PDA aim to prepare a person for decision making by :
providing facts about a person’s condition, the options and their features.
helping people to clarify their values (the features that matter most to them)
helping people to share their values with their health care practitioner
in order that a course of action can be planned that matches their values.
Studies have shown that patients with inflammatory arthritis have a high need of information and want to be more actively involved in medical decision-making 1. Medical decisions in this population focus primarily on the management of the disease with conventional synthetic and biologic disease modifying anti-rheumatic drugs. Despite an increasing range of disease modifying agents which halt disease progression in auto immune and inflammatory forms of arthritis , poor patient adherence with medication remains a significant barrier to successful management 2 .As the evidence to support traditional educational interventions efficacy at improving medication adherence is mixed 3 , the use of innovative consumer centric approaches such as PDA are increasing.
A recent Cochrane review4 of the efficacy of PDA for screening and treatment concluded that the largest and most consistent benefits of decision aids, relative to usual care, are better knowledge of options and outcomes, more accurate perceptions of outcome probabilities, and congruence between the chosen option and the person’s values. However review limitations included the wide variability in the decision contexts and the elements within the patient decision aids. By focusing on PDA for a defined conditions, using specific appraisal elements5 and including a broader literature base, the aim of this review is to provide more focused and clinically relevant conclusions.
Search Strategy:. A full search terms will then be used across PubMed, CINAHL, Pyschinfo and EMBase along with grey literature searching. Key systematic reviews which will be mined for additional terminology. Studies published in English and meeting the inclusion criteria will be screened for further consideration.
Data synthesis: Analysis will be conducted on all main outcomes where possible.
JBI MAStARI will be used for quantitative pooled statistical analysis if appropriate. Effect sizes will be expressed as Odds ratios or mean differences as appropriate to the nature of the data.
Objective
The objective of this review is to identify, appraise and synthesis the current evidence for the efficacy of patient decision aids to improve self management outcomes by improving medication knowledge and reducing decisional conflict for individuals living with inflammatory arthritis.
References
1. Voshaar MJ, Nota I, van de Laar MA, van den Bemt BJ. Patient-centred care in established rheumatoid arthritis. Best Practice & Research Clinical Rheumatology Dec 31;29(4):
2.Joplin S, van der Zwan R, Joshua F, Wong PK. Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BioMed research international Apr 28;2015.
3. Trevena LJ, Barratt A, Butow P, Caldwell P. A systematic review on communicating with patients about evidence. Journal of evaluation in clinical practice Jan 1;12(1):  
4.Elwyn G, O'Connor AM, Bennett C, Newcombe RG, Politi M, Durand MA, Drake E, Joseph-Williams N, Khangura S, Saarimaki A, Sivell S. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PloS one Mar 4;4(3):e4705.
5.Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. The Cochrane Library Jan 28.
Acknowledgments
The author would like to acknowledge the support of Arthritis SA