Bridging the Gap Between Complexity and Care: Translating Network Meta-Analysis into a Meaningful Tool for Patients with Rheumatoid Arthritis

Objectives To develop and evaluate a patient-centered decision aid that translates network meta-analysis (NMA) data into clear, accessible information supporting shared decision-making for patients with rheumatoid arthritis (RA) experiencing an inadequate response to TNF inhibitors (TNF-IR).

Methods A 2-page decision aid was designed to compare treatment efficacy data for patient switching therapies after TNF-IR. Relative treatment effects for ACR50 response for second-line biologic and targeted synthetic DMARDs were derived from an NMA of clinical trials.[1] These effects were converted into real-world outcome probabilities using data from a Canadian observational study of outcomes after TNF-IR.[2] We explored various data presentation formats to understand preferences among patients and rheumatologists, testing variation in how treatment benefits were scaled, grouped, and displayed.[3] Feedback was collected through semi-structured interviews with patients and a survey of the Canadian Rheumatology Association Guidelines panels.

Results Six semi-structured interviews with patients living with RA provided multiple diverse perspectives on treatment decision-making. Thematic analysis highlighted a strong need for more comprehensive and accessible information than what patients typically receive from health care providers. Patients explained the emotional and cognitive challenges of switching treatment and expressed that more comprehensive information could reduce uncertainty. They value resources that improve understanding and confidence in choosing treatments. They also valued time to review treatment options before appointments, allowing them to prepare questions and engage more confidently with their rheumatologist. A key theme was information gaps; this caused an increase in patients’ reliance on clinicians. Many patients explained how limited knowledge and confidence led them to defer to their rheumatologist’s judgment when making decisions. Patients responded positively to the prototype decision aid, appreciating its clarity, relevance, and inclusion of Canadian scaled data. Percentages were preferred over point estimates, and responders valued content reflecting real-world clinical experiences. Physician survey responses (n=7) reinforced the value of decision aids in clinical care and overall aligned with patient feedback (Table 1).

Conclusion Implementing a patient-centered decision aid that provides accessible, localized information can enhance understanding, confidence, and engagement in treatment planning for patients with RA. Improving how data are presented supports informed treatment choices and strengthens shared decision making in RA care and beyond. By bridging the gap between complex evidence and patient experience, this approach supports evidence-informed and value-based care. This could be used to implement similar tools across chronic disease contexts and strengthen shared decision making overall.

References [1.] MAGIC Evidence Ecosystem Foundation. https://www.magicevidence.org/match-it [2.] Bessette L. J Rheumatol 2024;51:145-54. [3.] Nota I. Arthritis Care Res (Hoboken) 2022;74:875-8.