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A New Approach for Effective Gout Treatment
Singapore researchers developed a new feasible tool to enable joint doctor-patient decision making towards effective gout treatment.

Image by cnick from Pixabay

A new feasible tool for gout treatment has been developed through a qualitative research study conducted by SingHealth Polyclinics (SHP). Breaking away from the traditional method of doctors directing the exact remedy for their patients with gout problems, the new approach via a Patient Decision Aid (PDA), enables patients to make a shared decision with their doctors on their treatment.

Gout treatment has not been optimised globally, and this disease has been on the rise over the years. Poorly controlled gout will lead to gout tophi and joint deformities with functional loss, which will impact the quality of life. In Singapore, a study shows that at least 4.1 per cent of adults in the local population suffer from gout. At SingHealth Polyclinics, over 12,400 patients were seen relating to gout, with an increasing trend year by year.

This has brought about the concern to overcome the physician-patient barriers towards treatment. Some of these barriers include the physician’s lack of understanding of their patients’ needs and lifestyles, and the patient’s misperception of treatments and its effectiveness. A Patient Decision Aid (PDA), which support joint decision making in selecting treatment options with due consideration to the user's values and preferences, may help to relieve these barriers towards gout treatment.

Using the PDA technique also benefits the physicians as it allows them to better understand their patients’ lifestyles, needs, and preferences. This enables them to select the best treatment plan that the patient will likely adhere to. It also helps patients to take ownership of their own health by understanding their condition better, and the different types of treatments available.

The content and design of the PDA were created from the ground up and co-developed by both patients and physicians through one-to-one in-depth interviews (IDIs) and focus group discussions. The concept of thematic analysis was used to derive the PDA, where the same feedback or ideas that were repeatedly shared across multiple interviews and focus group discussions were assessed.

The study was conducted at Pasir Ris Polyclinic with a total of 26 participants who were selectively chosen. They included 11 Family Physicians and 15 adult Asian patients aged 21 years and above with gout problems and were treated with Allopurinol. As gout affects mostly men, the majority of the patients recruited were male.

Using the Ottawa decision support framework (OSDF), which is largely used in the development of PDAs as a guide, together with the gathered feedback from the IDIs and focus group discussions, the gout treatment PDA prototype was designed based on the latest evidence by a multidisciplinary team. The team comprised primary care physicians, a rheumatologist, a nurse, a pharmacist, a dietitian, and a medical student.

The PDA will be used by primary care physicians to guide their patients through their conditions and treatment choices. The initial page educates the basic knowledge of what gout is, followed by delving into more information, such as the different types of treatment options, side effects, costs, and ultimately the type of treatment suitable for the individual.

“From the study, we concluded that patients and doctors have very different opinions of the amount of information to be included in the PDA. For example, patients reported that the amount of information in the PDA is adequate, while the doctors prefer to include more information to portray the pathophysiology and differentials of gout,” said Dr. Meykkumar S/O Meyappan, Associate Consultant at Pasir Ris Polyclinic. Dr. Meykkumar is also the main author of this study.

“Although there were many differed opinions in the study, all the participants understood the final layout and contents of the PDA. In addition, patients’ feedback that the one-page summary of treatment options raised their awareness of available therapeutics, and they were ready to try it out with their doctors to improve their gout condition,” added Dr. Meykkumar.

“We believe that shared decision making will reduce the gap of poor adherence towards gout treatment. Such [an] approach focuses on the patients’ autonomy where patients will be more willing to accept the type of treatment because the doctor puts their lifestyles and concerns into consideration. Ultimately, the patient is the recipient of the treatment, not the doctor,” said Clinical Associate Professor Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).

“This is a clinical care plan that we as family physicians are analysing to improve the condition of our patients with gout problems. More evaluation will have to be done on the shared decision tool to validate for clinical practice,” added Dr. Tan.

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