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Effect of communicating personalized rheumatoid arthritis risk on concern for developing RA: A randomized controlled trial

Author information

Marshall AA1, Zaccardelli A2, Yu Z3, Prado MG4, Liu X5, Miller Kroouze R6, Kalia SS7, Green RC8, Triedman NA9, Lu B10, Deane KD11, Iversen MD12, Karlson EW13, Sparks JA14. Patient Educ Couns. 2018 Dec 10. pii: S0738-3991(18)30557-3. doi: 10.1016/j.pec.2018.12.011. [Epub ahead of print]

Abstract

Author information 1 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Tufts University School of Medicine, 145 Harrison Avenue, 02111, Boston, MA, USA. Electronic address: Allison.Marshall@tufts.edu. 2 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: azaccardelli@bwh.harvard.edu. 3 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: zhy872@mail.harvard.edu. 4 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: pradom@bu.edu. 5 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: xliu42@bwh.harvard.edu. 6 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: Rmillerkroouze@gmail.com. 7 Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA. Electronic address: sarah.kalia@gmail.com. 8 Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA; Department of Medicine, Division of Genetics, Brigham and Women's Hospital, 77 Avenue Louis Pasteur, NRB Rm. 250, 02115, Boston, MA, USA; Broad Institute, 415 Main Street, 02142, Cambridge, MA, USA. Electronic address: rcgreen@bwh.harvard.edu. 9 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA. Electronic address: ntriedman@wesleyan.edu. 10 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA. Electronic address: blu1@bwh.harvard.edu. 11 Division of Rheumatology, University of Colorado School of Medicine, 1635 Aurora Court, 80045, Aurora, CO, USA. Electronic address: Kevin.Deane@ucdenver.edu. 12 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA; Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 301 Robinson Hall, 360 Huntington Avenue, 02115, Boston, MA, USA; Department of Women's and Children's Health, Karolinska Institutet, SE-177 77 Stockholm, Sweden. Electronic address: m.iversen@northeastern.edu. 13 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA. Electronic address: ekarlson@bwh.harvard.edu. 14 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA. Electronic address: jsparks@bwh.harvard.edu.

Abstract

OBJECTIVE: To investigate the effect of providing comprehensive personalized risk information on concern for chronic disease development.

METHODS: Unaffected first-degree relatives (FDRs) of rheumatoid arthritis (RA) patients (n = 238) were randomly allocated to: 1) disclosure of RA risk personalized to demographics, genetics, biomarkers, and behaviors using a web-based tool (PRE-RA arm, n = 78); 2) PRE-RA with interpretation by a health educator (PRE-RA Plus arm, n = 80); and 3) standard RA education (Comparison arm, n = 80). Concern for developing RA was assessed at baseline and immediately, 6 weeks, 6 months, and 12 months post-intervention.

RESULTS: FDRs randomized to PRE-RA arms were less concerned about developing RA than the Comparison arm at all post-intervention assessments (p < 0.05). Among those concerned about RA risk at baseline, the PRE-RA (OR = 4.7, 95%CI 1.5-14.4) and PRE-RA Plus (OR = 5.2, 95%CI 1.6-17.3) arms were more likely to have reassurance 6 months post-intervention than the Comparison arm.

CONCLUSION: A comprehensive tool provided reassurance to those at risk for developing a chronic disease, with or without interpretation from a health educator, compared to standard education.

PRACTICE IMPLICATIONS: Individuals may be more likely to be reassured using a personalized chronic disease risk disclosure tool than a standard non-personalized approach.