Author: Kate Roche (United Kingdom)
Co-authors: Anusha Phillip, Jessica Moll
Purpose
The purpose of this research was to understand if the known benefits of shared decision-making (SDM) were reflected in physician and patient data on neovascular age-related macular degeneration (nAMD) in the UK and EU4. To examine this, we investigated the relationship between patient involvement in treatment decisions, treatment strategy and perceived adherence to treatment.
Setting/Venue
Patient involvement in decision-making, or SDM, is becoming more commonplace in healthcare. Numerous benefits of SDM have been shown, including treatment plans that align more closely with patients’ goals, improved patient-physician communication and positive effects on patient outcomes. SDM also improves patient understanding of their disease and consequently patient adherence to treatment. With adherence to loading dose being an important aspect in the treatment of nAMD, SDM could ensure patients understand its importance. This research investigates whether the increase in SDM in healthcare is reflected in the area of ophthalmology, specifically in the management of nAMD.
Methods
A multi-country, multi-centre, online medical chart review study of patients with nAMD was conducted in October 2020 to December 2020. Data were collected from 286 ophthalmologists and retinal specialists in the UK and EU4 (UK – 50; FR - 60; DE – 72; IT – 51; ES – 53), who were recruited from a respondent access panel, had been practicing for 3-35 years and had seen ≥ 10 nAMD patients in the last 3 months. Physicians in hospitals and office practices answered a perceptual questionnaire which asked about treatment management, awareness of clinical trials, drugs in development and attribute importance. They also provided de-identified demographic, disease and treatment data on the last 6-8 nAMD patients seen. Data were analysed using descriptive statistics.
Results
In the UK, 54% (n=360) of the reported nAMD patients were highly involved in their treatment decision, the highest proportion of all the countries studied. The UK also had the highest proportion of physicians (48%, n=50) reporting that all their nAMD patients received the labelled anti-VEGF loading dose, as well as the lowest proportion of physicians (5%, n=37) stating the reason for nAMD patients not currently receiving treatment as “patient drop-out or non-compliance”. In the study markets overall (UK and EU4 combined), patients with high involvement in their treatment decision had a pro-re-nata (PRN) regimen planned (37%, n=246) more often than patients with low involvement, who were more likely to have an intended treat and extend strategy (43%, n=161). This suggests that patients might favour a PRN approach.
Conlusions
The data suggest a relationship between patient involvement in treatment decision and perceived compliance. The UK data shows that over half of reported patients had high involvement in their current treatment decision and UK physicians also perceive most of their patients receive the full loading dose and are least likely to not receive treatment due to non-compliance. This suggests an increase in the confidence of patients in their treatment, perhaps relating to an increased understanding of their disease and the importance of treatment and therefore compliance. The data further suggest that higher patient involvement may influence the planned strategy for treatment, with more involved patients appearing to prefer a PRN approach. We believe this is likely to be due to having the security of a monthly appointment and the potential reduction in the number of injections needed. The trend perhaps reflects, in line with SDM, increased physician willingness to take patient preferences into account. However, further investigation would be needed to determine if this is the case.
Financial Disclosure
None
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