Enhancing the treat-to-target approach of inflammatory arthritis with purposeful shared decision-making: results of a randomized controlled trial.

Authors

Yasser El Miedany, Maha Elgaafary, Susan Plummer, Sami Bahlas, Safaa Mahran, Deborah Palmer, Waleed Hassan, Walaa Elwakil, Ali El Miedany

Published in

Clinical rheumatology. Jun 28, 2026. Epub Jun 28, 2026.

Abstract

Purposeful SDM (PSDM) is a problem-based approach that emphasizes the multifaceted nature of SDM in response to different settings and contexts.
To evaluate the effectiveness of a novel approach utilizing patient decision aids in facilitating purposeful shared decision-making within the context of rheumatology care.
This randomized controlled study included 431 patients diagnosed with inflammatory arthritis. The patients were randomized to receive management according to either the traditional standard care protocol (215 patients) or the purposeful shared decision-making (PSDM) approach (216 patients), which utilizes structured communication tools. At the end of 1 year of intensive therapy, 6 key outcomes were be assessed to measure the impact of PSDM: clinical remission, medication adherence, treatment cessation, patient motivation, multidisciplinary engagement (contact and utilization rates of the helpline facility), and comprehensibility.
At 12 months of treatment, 84.3% of the PSDM group achieved treatment target scores, which was significantly higher than the control group, where 62.3% achieved the target. The patients' adherence to anti-rheumatic therapy, as well as comprehensibility, was significantly higher (p < 0.1) in the PSDM group in comparison to the control group (p < 0.01). Patient motivation scores were significantly higher in the PSDM group (p < 0.01). The percentage of patients who contacted the help line from the control group was significantly higher, in contrast to the PSDM group (p < 0.01).
Using rheumatology-specific PSDM tools aids in improving patients' knowledge and supporting communication with their clinicians on treatment benefits and risks. PSDM strategies may improve implementation of the treat-to-target approach. Addressing the variable modes of shared decision-making beyond weighing treatment options improves patients' understanding of the disease. Key Points • Shared decision-making (SDM), a collaborative process where clinicians and patients jointly arrive at meaningful healthcare decisions. • Purposeful Shared Decision-Making (PSDM) is a problem-based approach that acknowledges the multifaceted nature of SDM, adapting its application to diverse settings, patient needs, and decision types. • A PSDM framework, supported by patient decision aids, demonstrably improves critical outcomes in patients with inflammatory arthritis and spondyloarthritis. • By fostering deeper patient understanding, increasing adherence, boosting motivation, and reducing reliance on external support, PSDM facilitates better disease control and patient empowerment.

PMID:
42365560
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

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