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Using a Discrete-Choice Experiment in a Decision Aid to Nudge Patients Towards Value-Concordant Treatment Choices in Rheumatoid Arthritis: A Proof-of-Concept Study


Patient Prefer Adherence. 2020 May 18;14:829-838. doi: 10.2147/PPA.S221897.eCollection 2020.

Glen S Hazlewood 1 2 3, Deborah A Marshall 1 2 3, Claire E H Barber 1 2 3, Linda C Li 3, Cheryl Barnabe 1 2 3, Vivian Bykerk 4 5, Peter Tugwell 6, Pauline M Hull 7, Nick Bansback 3 8

Author Information

1 Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.

2 McCaig Institute of Bone and Joint Health, University of Calgary, Calgary, Canada.

3 Arthritis Research Canada, Vancouver, BC, Canada.

4 Weill Cornell Medical College, Cornell University, New York, NY, USA.

5 Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA.

6 Department of Medicine, Department of Epidemiology and Community Medicine, Canada Research Chair, University of Ottawa, Institute of Population Health, Ottawa, Canada.

7 University of Calgary, Calgary, Canada.

8 Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada.

Free PMC article


Purpose: To evaluate, in a proof-of-concept study, a decision aid that incorporates hypothetical choices in the form of a discrete-choice experiment (DCE), to help patients with early rheumatoid arthritis (RA) understand their values and nudge them towards a value-centric decision between methotrexate and triple therapy (a combination of methotrexate, sulphasalazine and hydroxychloroquine).

Patients and methods: In the decision aid, patients completed a series of 6 DCE choice tasks. Based on the patient's pattern of responses, we calculated his/her probability of choosing each treatment, using data from a prior DCE. Following pilot testing, we conducted a cross-sectional study to determine the agreement between the predicted and final stated preference, as a measure of value concordance. Secondary outcomes including time to completion and usability were also evaluated.

Results: Pilot testing was completed with 10 patients and adjustments were made. We then recruited 29 patients to complete the survey: median age 57, 55% female. The patients were all taking treatment and had well-controlled disease. The predicted treatment agreed with the final treatment chosen by the patient 21/29 times (72%), similar to the expected agreement from the mean of the predicted probabilities (68%). Triple therapy was the