Xeljanz first qualitative research rheumatologists - gfk.comQUALITATIVE RESEARCH AMONG ... GfK NL....

QUALITATIVE RESEARCH AMONG RHEUMATOLOGISTS EU – THE NETHERLANDS A QUALITATIVE STUDY ABOUT THE RHEUMATOLOGIST PERSPECTIVE ON COMMUNICATION ABOUT AND MANAGEMENT OF RHEUMATOID ARTHRITIS (RA)

©GfK | September 2016 | Edwin Bas | Martin de Bruin

2 © GfK September 28, 2016 | Jack Russel association test & narRative

1. Qualitative Research Background


The NarRAtive

Reason qualitative research & objectives

General objective:

• Identify the needs and treatment goals of

rheumatologists when treating medium to

severe RA

Specific issues:

• Is there any unmet need amongst

rheumatologists? Is it true that

rheumatologists are totally satisfied with the

current medication for treating RA ?

Qualitative research: How?

Face-2-face (single) interviews

10 rheumatologists, 5 in studio

60 minutes interview each

Interviewer guideline covering the following

subjects

The practice of the rheumatologist

The narRative: how do patients feel about their

treatment, what are their concerns, who decides,

et cetera & reactions towards two illustrating

images of patients hiding their feelings


After introduction respondents:

Checklist (in short)

narRAtive How do patients feel about their treatment? How do you know? Who should

take the initiative to talk about this? Which concerns do patients have?

Who takes part in the making of the treatment plan? How do you keep in pace

with the results (with objective measures or subjective – PRO’s)? Which

aspects of the treatment are worth to explain to the patient?

What aspects are important in explaining available medications? When do

you think a treatment is successful, is there any way of improving the success

rate? How can you tell if a patient is satisfied with the medication? Do you

change medication if a patient asks?

Desires & wishes concerning treatment and medication.

Reactions towards two images about patients hiding their feelings.


2. Management summary


NarRative

Observations Advice

• Patient complaints do not necessarily mean that

RA is not treated effectively.

• Complaints with no clear RA cause should be

addressed by nurses or redirected to other

specialisms, rheumatologists tell us.

• Rheumatologists do have the desire to improve

their treatment. So, if there are complaints which

clearly can be linked to the development of RA,

this is worth telling.

• For example, the causality of the relation

between RA and fatigue could be explained more

to plea for medication that decreases these

complaints. If there is evidence that fatigue is

inseparably linked to RA, this should be shared.

But it remains to be seen if this is enough reason

to prescribe JAK pathways.

• Some patients are more difficult to treat than

others. The observation that the treatment isn’t

good enough is a dangerous one: if you share

this observation rheumatologists could feel a bit

insulted. But maybe it is safe enough to say that

treating RA sometimes can be difficult and in that

case JAK pathways could be the way to go.

• RA nurses play an important role in identifying

and dealing with complaints other than

inflammations or pain. If there are any notable

differences between (f.i. fatigue) scores of

traditional medicaments and JAK pathways, it

could be considered to target RA nurses to make

them ambassadors. They could bring this

working mechanism under the attention of

rheumatologists when discussing the patient.


3. Results: narRative


How do patients feel about their disease and treatment?

First consult

Patient

• First consult patients present themselves

with complaints (pain, joint stiffness, what

they cannot do anymore)

• First patient objective: no more pain and

no problems with their job, hobbies or

taking care of children/family. Patients are

used to tell the doctor this spontaneously.

• First worries: wheelchair? Can I do my

job? Will I get rid of the pain? What is my

future?

Rheumatologists

• First consult listens and explains RA.

Starts with treatment plan and tells what is

realistic to expect. Assessment with regard

to patient complaints and posing questions

to comprehend the severity of RA for the

patient

• Explaining: treatment/medication/side

effects is essential and mandatory

• Most rheumatologists try to reassure the

patient that medication nowadays is very

effective

• For more details and explaining the RA

nurse is introduced


How do patients feel about their disease and treatment?

Following consults

Patient

• Patient started the treatment and the pain

reduction, side effects of medication, shock

of having RA is lessening

• The patient is starting to ask more questions,

knows more about medication and what to

expect (RA nurse, external information

sources)

• Worries change: asking for less hospital

visits because of the job, alternative

medication, side effects (esp. MTX nausea),

sports, fatigue

Rheumatologists

• Always asks how the patient is doing in every

day life. RA nurse knows often about feelings

and side effects, worries and therapy

compliance and informs rheumatologist

(fatigue comes with the disease, is not seen

as a side effect of medication)

• Always talk about treatment medication Mostly

patient is taking the lead in talking about side

effects and worries

• Child wish is always checked (change

medication). Patients generally express

difficulties with coping with the disease (like

depressive complaints) with the nurse.


Treatment plan: role, results and adjustments

Following consults

Patient

• Patient is more and more partner

in the RA treatment

• If patient express the wish to

change medication, the treatment

plan is often changed (lower

dosage first and next change

medication or add medication)

• Treatment is successful for

patients if they can function as

normal people (almost as before

RA)

Rheumatologists

• Treatment plan is an advice. Expertise and

trust is essential for therapy compliance.

Patient has to agree otherwise a treatment

plan will not be successful. The doctor

expects and encourages self management.

• When the patient is in doubt there will be a

call, or when a patient is suffering from

severe side effects: medication is stopped

and there will be a call as well.

• Objective measures rule, PRO’s are very

important as well. If DAS is suboptimal,

subjective measures sometimes are enough

for adjusting treatment.


When patient satisfied and when is treatment successful?

Perception of rheumatologist

Patient is satisfied when they tell

• Happy with functionality in everyday life

• No pain

However, dissatisfaction is more often shared

than satisfaction with the doctor or RA nurse.

You know they are satisfied because

• You ask (each visit) about side effects and

medication etc. and

• they start to forget taking medication

• they stop complaining

Rheumatologists consider treatment successful

because of

• Good clinical results, DAS low

• No inflammation, no swelling joints

• No pain

Both matter. Sometimes issues:

1. No inflammation – however pain

2. No pain – however inflammation

!!! if inflammation in one or more joints, the treatment is

considered not to be successful. If – at the same time –

the patient is satisfied with his functionality and has no

pain (although DAS results are suboptimal) the treatment

still might be (temporarily) ceased.


4. Results: questionnaire


Tables questionnaire patient interaction

• Rheumatologists think patients don’t need

to talk more than they already do about

their objective of the RA treatment

• They would like themselves to talk less or

the same on the RA treatment objective

• They are satisfied with their own

communication with RA patients on their

RA treatment

• The majority changes regularly the treatment plan

without consulting the patients or letting them co decide

• The majority wants to see their RA patients more often

• They think patients do not fully understand their disease

and the treatment options

• The majority feels that patient contact suffers from

administration procedures linked with RA treatment

No major differences found in opinions of

‘empathic’ or ‘scientific’ oriented

rheumatologists in patient involvement in

RA treatment


Table questionnaire on treatment and patient oriented approach

• If patients should take more responsibility for the management of

their disease (RA) rheumatologists have different opinions

• They don’t feel that patients who are member of a patient

organization are more able to cope with their disease (RA)

• They think sufficient information material is available to inform

patients on their disease

• The majority of rheumatologists encourage

patients to talk about the impact of RA on

their everyday life

• They think the consideration and

interpretation of patient reported

observations of utmost importance for the

treatment plan

• They don’t think that patients consider

constant pain and loss of self-reliance a

inseparably linked to life with RA

Rheumatologists consider patient

experiences and observations in

the treatment of RA


6. Appendices


The project team

Edwin Bas is the Industry Director of

the healthcare sector at GfK

Netherlands. Before GfK, he founded

and worked at Phibase, a company

specialized in consultancy and advice in

Healthcare. It total, he has more than

20 years of experience in the

pharmaceutical industry..

Role in the project: input concerning

industry, results and set up

Martin de Bruin is Head of the

Qualitative Intelligence department of

GfK NL.

Martin has 16 years of experience as a

qualitative researcher in various

industries, amongst which Healthcare.

The research was in his hands. Set –

up and presentation in close

coordination and corporation with

Edwin.

[email protected]

+ 31 – (0)6 – 205 95 103

GfK is known worldwide for its robust

and trusted way of performing market

research.

In 2016 this has led to winning the MOA

Award, a price for the best company

vision on Market Research.

We believe we can connect various

sources of data into powerful insights.

That is why the jury thought we had to

win this award. We’re very proud!

mailto:[email protected]


Quality assurance

GfK offers high-quality products and services in the field of market research, based on techniques from the

social sciences, both in qualitative and quantitative nature. Starting point is primarily to meet the needs of

the customer as much as possible.

The quality is also guaranteed by external regulators.

GfK is a member of the MOA, (Center for Information Based Decision Making & Marketing Research)

and thus abides by the delivery and payment conditions of this professional organization. An outline of

these MOA conditions is available on http://www.moaweb.nl.

GfK endorses the code of conduct of ICC/ESOMAR (European Society for Opinion and Market

Research), the International 'Code Market and Social Research'' of 1994, as published in the 'ESOMAR

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guidelines.html.

The study was conducted in accordance with GfK's quality system that is certified according to the

standard of NEN-EN-ISO 9001, ISO 20252 and 23632.

All documents with regards to the conducted market research will be stored digitally for three years.

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be made available to third parties, without the written permission of GfK.

For our general conditions, please see:

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