Xeljanz first qualitative research rheumatologists - gfk.comQUALITATIVE RESEARCH AMONG ... GfK NL....
Transcript of Xeljanz first qualitative research rheumatologists - gfk.comQUALITATIVE RESEARCH AMONG ... GfK NL....
QUALITATIVE RESEARCH AMONG RHEUMATOLOGISTS EU – THE NETHERLANDS A QUALITATIVE STUDY ABOUT THE RHEUMATOLOGIST PERSPECTIVE ON COMMUNICATION ABOUT AND MANAGEMENT OF RHEUMATOID ARTHRITIS (RA)
©GfK | September 2016 | Edwin Bas | Martin de Bruin
2 © GfK September 28, 2016 | Jack Russel association test & narRative
1. Qualitative Research Background
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The NarRAtive
Reason qualitative research & objectives
General objective:
• Identify the needs and treatment goals of
rheumatologists when treating medium to
severe RA
Specific issues:
• Is there any unmet need amongst
rheumatologists? Is it true that
rheumatologists are totally satisfied with the
current medication for treating RA ?
Qualitative research: How?
Face-2-face (single) interviews
10 rheumatologists, 5 in studio
60 minutes interview each
Interviewer guideline covering the following
subjects
The practice of the rheumatologist
The narRative: how do patients feel about their
treatment, what are their concerns, who decides,
et cetera & reactions towards two illustrating
images of patients hiding their feelings
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After introduction respondents:
Checklist (in short)
narRAtive How do patients feel about their treatment? How do you know? Who should
take the initiative to talk about this? Which concerns do patients have?
Who takes part in the making of the treatment plan? How do you keep in pace
with the results (with objective measures or subjective – PRO’s)? Which
aspects of the treatment are worth to explain to the patient?
What aspects are important in explaining available medications? When do
you think a treatment is successful, is there any way of improving the success
rate? How can you tell if a patient is satisfied with the medication? Do you
change medication if a patient asks?
Desires & wishes concerning treatment and medication.
Reactions towards two images about patients hiding their feelings.
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2. Management summary
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NarRative
Observations Advice
• Patient complaints do not necessarily mean that
RA is not treated effectively.
• Complaints with no clear RA cause should be
addressed by nurses or redirected to other
specialisms, rheumatologists tell us.
• Rheumatologists do have the desire to improve
their treatment. So, if there are complaints which
clearly can be linked to the development of RA,
this is worth telling.
• For example, the causality of the relation
between RA and fatigue could be explained more
to plea for medication that decreases these
complaints. If there is evidence that fatigue is
inseparably linked to RA, this should be shared.
But it remains to be seen if this is enough reason
to prescribe JAK pathways.
• Some patients are more difficult to treat than
others. The observation that the treatment isn’t
good enough is a dangerous one: if you share
this observation rheumatologists could feel a bit
insulted. But maybe it is safe enough to say that
treating RA sometimes can be difficult and in that
case JAK pathways could be the way to go.
• RA nurses play an important role in identifying
and dealing with complaints other than
inflammations or pain. If there are any notable
differences between (f.i. fatigue) scores of
traditional medicaments and JAK pathways, it
could be considered to target RA nurses to make
them ambassadors. They could bring this
working mechanism under the attention of
rheumatologists when discussing the patient.
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3. Results: narRative
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How do patients feel about their disease and treatment?
First consult
Patient
• First consult patients present themselves
with complaints (pain, joint stiffness, what
they cannot do anymore)
• First patient objective: no more pain and
no problems with their job, hobbies or
taking care of children/family. Patients are
used to tell the doctor this spontaneously.
• First worries: wheelchair? Can I do my
job? Will I get rid of the pain? What is my
future?
Rheumatologists
• First consult listens and explains RA.
Starts with treatment plan and tells what is
realistic to expect. Assessment with regard
to patient complaints and posing questions
to comprehend the severity of RA for the
patient
• Explaining: treatment/medication/side
effects is essential and mandatory
• Most rheumatologists try to reassure the
patient that medication nowadays is very
effective
• For more details and explaining the RA
nurse is introduced
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How do patients feel about their disease and treatment?
Following consults
Patient
• Patient started the treatment and the pain
reduction, side effects of medication, shock
of having RA is lessening
• The patient is starting to ask more questions,
knows more about medication and what to
expect (RA nurse, external information
sources)
• Worries change: asking for less hospital
visits because of the job, alternative
medication, side effects (esp. MTX nausea),
sports, fatigue
Rheumatologists
• Always asks how the patient is doing in every
day life. RA nurse knows often about feelings
and side effects, worries and therapy
compliance and informs rheumatologist
(fatigue comes with the disease, is not seen
as a side effect of medication)
• Always talk about treatment medication Mostly
patient is taking the lead in talking about side
effects and worries
• Child wish is always checked (change
medication). Patients generally express
difficulties with coping with the disease (like
depressive complaints) with the nurse.
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Treatment plan: role, results and adjustments
Following consults
Patient
• Patient is more and more partner
in the RA treatment
• If patient express the wish to
change medication, the treatment
plan is often changed (lower
dosage first and next change
medication or add medication)
• Treatment is successful for
patients if they can function as
normal people (almost as before
RA)
Rheumatologists
• Treatment plan is an advice. Expertise and
trust is essential for therapy compliance.
Patient has to agree otherwise a treatment
plan will not be successful. The doctor
expects and encourages self management.
• When the patient is in doubt there will be a
call, or when a patient is suffering from
severe side effects: medication is stopped
and there will be a call as well.
• Objective measures rule, PRO’s are very
important as well. If DAS is suboptimal,
subjective measures sometimes are enough
for adjusting treatment.
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When patient satisfied and when is treatment successful?
Perception of rheumatologist
Patient is satisfied when they tell
• Happy with functionality in everyday life
• No pain
However, dissatisfaction is more often shared
than satisfaction with the doctor or RA nurse.
You know they are satisfied because
• You ask (each visit) about side effects and
medication etc. and
• they start to forget taking medication
• they stop complaining
Rheumatologists consider treatment successful
because of
• Good clinical results, DAS low
• No inflammation, no swelling joints
• No pain
Both matter. Sometimes issues:
1. No inflammation – however pain
2. No pain – however inflammation
!!! if inflammation in one or more joints, the treatment is
considered not to be successful. If – at the same time –
the patient is satisfied with his functionality and has no
pain (although DAS results are suboptimal) the treatment
still might be (temporarily) ceased.
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4. Results: questionnaire
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Tables questionnaire patient interaction
• Rheumatologists think patients don’t need
to talk more than they already do about
their objective of the RA treatment
• They would like themselves to talk less or
the same on the RA treatment objective
• They are satisfied with their own
communication with RA patients on their
RA treatment
• The majority changes regularly the treatment plan
without consulting the patients or letting them co decide
• The majority wants to see their RA patients more often
• They think patients do not fully understand their disease
and the treatment options
• The majority feels that patient contact suffers from
administration procedures linked with RA treatment
No major differences found in opinions of
‘empathic’ or ‘scientific’ oriented
rheumatologists in patient involvement in
RA treatment
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Table questionnaire on treatment and patient oriented approach
• If patients should take more responsibility for the management of
their disease (RA) rheumatologists have different opinions
• They don’t feel that patients who are member of a patient
organization are more able to cope with their disease (RA)
• They think sufficient information material is available to inform
patients on their disease
• The majority of rheumatologists encourage
patients to talk about the impact of RA on
their everyday life
• They think the consideration and
interpretation of patient reported
observations of utmost importance for the
treatment plan
• They don’t think that patients consider
constant pain and loss of self-reliance a
inseparably linked to life with RA
Rheumatologists consider patient
experiences and observations in
the treatment of RA
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6. Appendices
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The project team
Edwin Bas is the Industry Director of
the healthcare sector at GfK
Netherlands. Before GfK, he founded
and worked at Phibase, a company
specialized in consultancy and advice in
Healthcare. It total, he has more than
20 years of experience in the
pharmaceutical industry..
Role in the project: input concerning
industry, results and set up
Martin de Bruin is Head of the
Qualitative Intelligence department of
GfK NL.
Martin has 16 years of experience as a
qualitative researcher in various
industries, amongst which Healthcare.
The research was in his hands. Set –
up and presentation in close
coordination and corporation with
Edwin.
+ 31 – (0)6 – 205 95 103
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