Patients identified important outcomes beyond those that are commonly evaluated. |
There is a need to establish how identified outcomes are represented in existing measures. |
The outcomes identified reflect patients’ treatment beliefs and influence their treatment decisions. |
1 Background
2 Methods and Patients
Key questions in focus groups |
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Which symptoms have the most effect on your well-being? |
What do you want from your treatment? |
What are the benefits and drawbacks of treatment for you personally? |
How do you know when you are in a flare? |
3 Findings
PsA phenotypes
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Polyarthritis (30) | Oligoarthritis (9) | Distal interphalangeal (18) | Axial (8) | Mutilans (1) |
Domains of disease activity
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Skin (34) | Joints (36) | Spine (7) | Eye (2) | Enthesitisa (14) |
Main theme | Subtheme |
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Symptom alleviation | Pain throughout the body Physical and mental fatigue Itching, flaking skin Inflammation, swelling and stiffness Reducing variability |
Reduction of disease impact | Overwhelming tiredness and pain Limited mobility and dexterity Deteriorating physical fitness Poor quality and disrupted sleep Negative emotional responses Strained relationships and social interactions |
Improved prognosis | Slowing down or halting disease progression Enabling independence to be maintained Enhancing quality of life, well-being and sense of normality |
Minimisation of harm and burden | Nausea and sickness Concerns about long-term effects Modes of administration Monitoring requirements |
3.1 Theme 1: Symptom Alleviation
“I get pain in various joints round my body at different times” [Dave, 71, FG5]“I seem to have it [pain] all over my body, mainly it’s my feet, my knees, legs” [Mel, 52, FG6]
“I’m always in pain it’s just how much” [Mark, 28, FG1]
“The most important thing is tiredness, just feeling I can sleep at any time” [Louise, 48, FG5]“It’s as if your brain’s fatigued, you know, it’s as if it’s something else, it’s not just tired, it’s beyond that” [Judith, 65, FG8]“I feel so drained, so washed out, I can’t be bothered” [Ameila, 75, FG8]
“The more the disease is controlled by the drugs, the more the fatigue is a problem” [Adam, 41, FG3]
“The psoriasis side of it is a big part for me … it’s not even really the response of other people it’s your perception of it …Yeah exactly …You feel horrible and scabby” [Paul, 50; Andrew, 72; and Miriam, 50, FG4]
“It was itchy and unsightly but not all that long after I started the medication it disappeared” [Natalie, 68, FG1]
“Inflammation just generally runs your body down anyway, your body constantly fighting and stuff” [Duncan, 56, FG6]“It’s these two joints [in hands] that are the worst and they’ve just become very swollen, incredibly tender, very stiff” [Alison, 66, FG5]
“I had to leave the medication off for about three months and then I realised the medication was working because then the flare ups began” [George, 70, FG2]“Overnight it was just out of control and I did manage to get an appointment and had bloods taken and then my inflammation had just gone sky high” [Nicky, 50, FG4]
3.2 Theme 2: Reduction of Disease Impact
“You’re continuously drained during the day, and you can’t concentrate on whatever you’re trying to do, whether it’s driving, working, walking, anything” [Siddiq,39, FG6]“The pain and the consequences of the pain in terms of immobility, in terms of moods and depressions, and feeling low and so on” [Andrew, 72, FG4]
“It’s lack of mobility that affected me and standing out therefore in the work place, having people stop at the bottom of the stairs to let you up or down and just not being normal” [Miles, 61, FG8]“I have it in my thumb, which is annoying, because I’m an artist, and when it’s stiff I get frustrated because I can’t quite do what I used to” [Claire, 44, FG3]
“I was quite a fitness freak, I used to go running, go to the gym, I had a very, very active life. I miss that” [Kate, 61, FG2]“When I’m not well I can’t cycle and then I start putting on weight” [Janet, 65, FG1]
“The discomfort because that hip, that shoulder, my back, and you see you just don’t have a good night’s sleep, ever” [Joanna, 57, FG4]“Nothing seems to work, so lack of sleep is becoming vital now” [Sue, 75, FG5]
“I’m treated for anxiety and depression as well because of lack of sleep basically and constantly being in pain and run down” [Justin, 44, FG6]“I do feel like it’s affected my emotion, I’ve become quite angry and resentful” [Abby, 41, FG7]
“I have to constantly explain to my work, my wife, my children, my family, my friends why I’m not going out, why I’m not doing this, and so yeah, that makes me feel quite, the emotional side of that makes me quite insular” [Mark, 28, FG1]“Mentally it’s massive and I find it’s hard to get other people to recognise it as well … I was in a marriage for 21 years and it was a big effect on that marriage” [Stephen, 43, FG3]
3.3 Theme 3: Improved Prognosis
“They said it will stop your disease activity so it won’t, your bones won’t fall to bits effectively” [Miriam, 50, FG4]“The worry is always there that this is going to get worse and worse” [Alison, 66, FG5]
“If I could have anything it would be independence, it would be to be able to be as fast as everybody else, it will be able to drive my own car, go out when I wanted to go out, come in and lock my own front door and not have somebody to come in to help with the shower” [Judith, 67, FG8]“I live alone and I want to keep my independence” [Flora, 59, FG7]
“I have got a shorter life because of the amount of drugs that I take, I know that it is going to restrict my lifestyle. I have always said I want a good quality even though it is short; I don’t want to live until I am 90 and be curled up in a ball somewhere, I don’t want that, I would rather keep taking the injections and keep going [Kate, 61, FG2]
3.4 Theme 4: Minimisation of Treatment Harm and Burden
“It [methotrexate] just made me feel so dreadful and I had every side effect … just couldn’t tolerate it … nausea and just everything, it was awful.I had much the same experience with methotrexate, I just felt dreadful all day, sick, general loss of appetite, lethargic” [Louise, 48, and Dave, 71, FG5]
“What the methotrexate can do, it can affect your immune system down a bit, and I feel I could be undoing all the good that they’re trying to do at haematology by taking it” [Stuart, 60, FG7].
“Just the thought of taking more medication and taking that long term, that bit worries me” [Claire, 44, FG3]“I think you could be doing yourself more harm than good at times by taking these drugs” [Michael, 69, FG5]
“I really don’t want to do my injection, or when I was taking the tablets, I don’t really want to gag” [Janet, 65, FG1]
“Access to the monitor side of it was part of the reason I stopped [treatment] because it didn’t suit my personal circumstances” [Chris, 44, FG2]