AB1278 ANNOUNCEMENT OF CHRONIC RHEUMATIC INFLAMMATORY DISEASE: THE RHEUMATOLOGIST’S POINT OF VIEW
Authors: patrick Lemesle, Xavier Grapton, Nabil Bouhedja
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The onset of a chronic rheumatic inflammatory disease (CRD) is a turmoil in a patient's life. The announcement, first step of information (a legal and ethical necessity), will leave a lasting impression in a patient's history. <h3>Objectives</h3> Determine the rheumatologist's methods to reveal a potentially disabling disease with an uncertain prognosis. Compare, in the discussion chapter, the rheumatologist's vision and the patient's experience at the time of the announcement. <h3>Methods</h3> 39 private practice rheumatologists from the CREER group. 52% women, mean age 59 years. 222 CRD including 56% rheumatoid arthritis (RA), 27% spondyloarthritis (SPA), 17% others. Survey including 31 questions. Direct eye contact 89%, gesture 56%, modulated tone 49%, silence 36%, compassional approach 26%. Gaining confidence by : availability, listening to, explanations, empathy, frankness. The rheumatologist thinks that he is reassuring and comforting 100%, empathic 98%, transparent 72%. He calms 42%, supports, is optimistic because he is sensitive to the patient's reactions 61%, but sometimes destabilized by a treatment refusal. He mentions life quality 51%, invites him to question it 58%, encourages him on a mutual management of the CRD 92% and insists on treatment compliance. He gives few documents, rarely mentions patient organizations, speaks about chronic disorder status, informs the treating physician and is always available. <h3>Results</h3> The announcement is different depending on : the type of CRD (59%), its presentation, the prognosis (29%), the induced emotion, the patient's profile, 82% (intellect 41%, personality 22%, age 16%), the information to provide (course, treatment). Duration of consultation : long 51%, doubled 64%. Time given to assimilate the information 93%, to discuss 90%. Explanations given 100%, rephrased 32%, repeated 27%, verified 9%. Announcement unchanged if patient alone or accompanied; handling adapted to its degree of worry. If patient is anxious, depressive, rebelious or denying : see him again 29%, re-explain 22%, listen to him, adapt. When comparing the rheumatologist's and the patient's assessment about the announcement, there is globally an agreement, but it's less affirmative for all the items. However, the patient thinks his rheumatologist more frank than he really is. Indeed, he announces with feeling and spends time on it, but not enough for the patient. He is less comforting, reassuring and explaining what he believes. He mentions the treatment inconveniences and life quality, which is well perceived. But he should guide more to annex treatments. For all the suggested items, the SPA patients are less optimistic then the RA patients. <h3>Conclusion</h3> the announcement takes into account above all the patient's profile, the type and the seriousness of the CRD. The rheumatologist dedicates a lot of time on the announcement, which is made step by step, but still too fast for the patient. He explains, listens to, reassures, comforts by using human methods to gain the patient's confidence. He supprts him and helps him to manage his disease. He involves the patient and stays available. The patient feels well informed and taken care of in his entirety with empathy. <h3>References</h3> [1] CREER group <h3>Disclosure of Interests</h3> None declared