OP0275-HPR ‘IT’S A LOT TO TAKE IN’: A SYSTEMATIC REVIEW OF THE INFORMATION NEEDS OF PEOPLE WITH INFLAMMATORY ARTHRITIS STARTING METHOTREXATE

Field: Health Professions (Health Sciences)

Background

Guidelines recommend that people with Inflammatory Arthritis have access to tailored information when starting treatment with Methotrexate (MTX) [1]. It is not known what information people with Inflammatory Arthritis (IA) need to take MTX. Many people have concerns about the risk-benefit profile of MTX and so do not start or continue MTX.

Objectives

To identify and synthesize knowledge of the characteristics, content and preferred format of information that people with IA need to take MTX.

Methods

A PROSPERO registered systematic literature search (CRD42022325249) was conducted using Medline, Embase, Cinahl, PsychInfo, GreyEU, Web of Science and Open Dissertation databases. All full-length articles and conference abstracts identifying information and support needs of people with Inflammatory Arthritis, and oral or sub-cutaneous MTX as the main conventional DMARD considered in the study were assessed for inclusion. The systematic review was conducted and reported in accordance with the Joanna Briggs Institute methodological guidance for Mixed Methods Systematic Reviews [2] using a convergent integrated approach and the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement.

Results

8468 studies were identified. 169 studies were reviewed by full text of which 13 studies met the inclusion criteria. Seven quantitative studies used cross-sectional internet (n=2), postal (n=2), and rheumatology clinic (n=3) surveys, two mixed methods studies, one cross-sectional survey with clinic observations and one cross-sectional survey and focus group, and four qualitative (one interview and three focus group) studies. The combined studies included 3425 adults over the age of 18 years (20-84 yrs), most were female (71%, n=2434). More people were enrolled into studies (n6) involving people with a diagnosis of Rheumatoid Arthritis (n=2278) than studies (n=7) involving people with IA (n=840). Studies were conducted in the UK (n=4), Netherlands (n=3), Spain (n=2), Australia (n=2), Canada (n=1) and Japan (n=1) and reported in English. Quantitative results were qualitized. Three main themes were identified, with an overarching theme of a need for person-centred information about Methotrexate. 1: Information to support understanding and acceptance of the need for treatment with MTX: Learning about IA diagnosis, rationale for MTX in context of IA, benefits of MTX) 2: Concerns about MTX: including risk, likelihood and management of side effects, drug interactions, impacts upon lifestyle, developing medication self-management skills 3: Content and methods of information delivery: information sources, importance of support from healthcare professionals (hcp), family and friends, value of a therapeutic relationship with hcp.

Conclusion

People with IA have individual, multi-faceted information and support needs about both their condition and MTX, to enable them to take MTX. Further research is recommended to explore a) the expectations of information and support before receiving information about MTX, b) experiences of people receiving information at the time of starting MTX and c) strategies to improve information and support during the course of taking MTX.

References

[1]Jones B, et al. Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with patients' perspectives. RMD open. 2022 Apr 1;8(1): e002256. [2]Stern C, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI evidence synthesis. 2020 Oct 1;18(10):2108-18.

Acknowledgements:

NIL.

Disclosure of Interests

None Declared.