Decision-making regarding medications to manage psoriatic arthritis is complex because of multiple disease manifestations and comorbidities. Fear of side effects from systemic medications and misalignment in priorities between patients with psoriatic arthritis and rheumatologists makes shared decision-making challenging. We aimed to describe the perspectives of patients with psoriatic arthritis on shared decision-making around medication taking.
Face-to-face semi-structured interviews were conducted with 25 adult patients with psoriatic arthritis in Australia. Transcripts were thematically analyzed.
Five themes were identified: lacking agency in decision making (denied choice, knowledge asymmetry, desperation and necessity, restricted by unfair eligibility criteria, automated approach); overwhelmed by potential harms (daunted by aggressive therapy, anticipating lifestyle disruption from side effects, jeopardizing fertility and pregnancy, avoiding relapse); gaining confidence (discernable benefit in function and mental health, sharpening knowledge over time, expertise of family and peers, empowered by information); opting for alternatives (pursuing normality, suspicion of over-medicalization, seeking comprehensive solutions); and developing trust and fortifying collaboration (assurance through a personable approach, seeking consistency, supported in decisional power, resolution through respectful negotiation).
Patients with psoriatic arthritis lack agency in making treatment decisions and are overwhelmed by the potential harms of systemic medication. Improving knowledge and trust with medical teams in a supportive and collaborative environment, and strategies for managing risks and side-effects may improve decision-making about pharmacological management of psoriatic arthritis.