270 research outputs found
Information and participation in decision-making about treatment: a qualitative study of the perceptions and preferences of patients with rheumatoid arthritis.
Objectives: To elicit the perceptions and preferences of
patients with rheumatoid arthritis regarding information
and participation in treatment decision-making. To analyse
the patientsâ narratives on the background of the ethical
discourse on various approaches to treatment decisionmaking.
Design: In-depth interviews with themes identified using
principles of grounded theory.
Participants: 22 patients with long-standing rheumatoid
arthritis.
Main outcome measures: Qualitative data on patientsâ
perceptions and preferences regarding information and
participation in decision-making about treatment.
Results: Decision-making about treatment has been
described by the patients as a process consisting of
different stages with shifting loci of control and
responsibility. Patients initially received one treatment
recommendation and were not aware of alternative
treatment options. Those participants in this study who
wanted information about negative effects of a treatment
cited ââinterest in oneâs own healthââ and the potential ââuse
of informationââ as reasons for their preference. The
physiciansâ expert knowledge and clinical experience
regarding the effects of medication were cited as
arguments by patients for a treatment recommendation.
Conclusions: The patientsâ accounts of decision-making
about treatment differ from models of physicianâpatient
relationship that have been put forward in ethical
discourse. These differences may be relevant with respect
to the starting point of an ethical analysis of treatment
decision-making. Patientsâ accounts with respect to a lack
of information on treatment alternatives point to ethically
relevant challenges regarding treatment decision-making
in clinical practice
Information and participation in decision-making about treatments: A qualitative study of the perceptions and preferences of patients with rheumatoid arthritis
ABSTRACT Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making
Immunological and Functional Properties of the Acetylcholine Receptor Expressed on the Human Cell Line TE671
Peer Reviewe
Evidence for treating rheumatoid arthritis to target: results of a systematic literature search
Objectives To summarise existing evidence on a target oriented approach for rheumatoid arthritis (RA) treatment. Methods We conducted a systematic literature search including all clinical trials testing clinical, functional, or structural values of a targeted treatment approach. Our search covered Medline, Embase and Cochrane databases until December 2008 and also conference abstracts (2007, 2008). Results The primary search yielded 5881 citations; after the selection process, 76 papers underwent detailed review. Of these, only seven strategic clinical trials were extracted: four studies randomised patients to routine or targeted treatment, two compared two different randomised targets and one compared targeted treatment to a historical control group. Five trials dealt with early RA patients. All identified studies showed significantly better clinical outcomes of targeted approaches than routine approaches. Disability was reported in two studies with no difference between groups. Four studies compared radiographic outcomes, two showing significant benefit of the targeted approach. Conclusion Only few studies employed randomised controlled settings to test the value of treatment to a specific target. However, they provided unanimous evidence for benefits of targeted approaches. Nevertheless, more data on radiographic and functional outcomes and on patients with established RA are needed
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