Abstract
Objective Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians.
Methods Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool.
Results Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve.
Conclusion A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA.
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