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Tracy French

Rheumatology Clinical Nurse Specialist

Patients with chronic conditions who are well-informed and feel empowered are more likely to adhere to treatments and cope better with the challenges of their illness.

Health professionals observe that shared decision-making with patients with illnesses such as rheumatoid arthritis (RA) can improve outcomes and increase patient satisfaction.

Empowering patients

Tracy French, a Clinical Nurse Specialist in Rheumatology at University Hospitals Bristol & Weston NHS Foundation Trust, sees patients with RA — an autoimmune inflammatory disease — face-to-face in clinics and offers support over the phone. But she remains acutely aware of the limited time healthcare professionals have with patients.

This underlines the importance of patients playing a role in managing their health with the support of healthcare personnel. Educating RA patients about their medication, disease and lifestyle changes enables them to be better informed, which means they gain more from their interactions with health professionals.

“A well-informed patient is happier and more likely to engage with their care,” adds Tracy.

National survey

A recent survey by the National Rheumatoid Arthritis Society (NRAS), in association with pharmaceutical company medac Pharma, found that 45% of RA patients felt they could not voice concerns about treatment options.

However, Tracy and other RA teams are keen to share information with patients with chronic conditions so they can be better prepared for consultations and come with specific questions. This ensures all concerns are discussed and addressed and leads to a better treatment experience and outcome.

Tracy, who worked with the NRAS on follow-up resources for the survey, says: “It is about a patient not being a passive recipient in the process. The idea is to share treatment options and enable the patient to be a part of that decision-making process.”

“As health professionals, we want people to engage because they are more likely to take their treatment and feel listened to.”

But consultations can go beyond medication to include broader issues of concern for patients.

Medication options

Giving a patient the confidence to discuss medication and realise there are choices and alternative options — and that they are part of the medication decision-making process — means they are more likely to adhere to their medication, she says.

But consultations can go beyond medication to include broader issues of concern for patients.

“We focus on assessing and managing disease and tweaking medications. But for the patient, it might be something completely different that is important and affecting their quality of life such as social, psychological or sexual issues. Those can have a massive impact on a long-term health condition and are things the patient may need to talk to somebody about, and the nurse is in a good position to do that.”

Difficult issues

In her clinic, Tracy and her colleagues give patients a focus form that not only asks about medical issues such as fatigue, joint stiffness, pain, infections and missed treatments. It has additional topics a patient can circle if they want to discuss it, such as sex, work, finances or weight. The form can give patients the forum and confidence during a consultation.

“There is nothing worse than having a negative consultation with a patient, but the best part of my job is when somebody comes back after we have talked about losing weight, for example, and they are ‘chuffed’ to tell me they achieved that.”

“That is when you feel that patient was empowered and did take control.”

Treatment preferences

Experts say if patients know the benefits and side effects while understanding different treatment formats, it can lead to a better treatment experience.

“If patients come prepared to a consultation and have done some research, they are already engaged and can get the best out of the time they have with a health professional,” says Tracy. However, she also acknowledges that not all patients want to be as active in their care or discuss issues in detail. But they are happy to know they have that option and retain trust in their healthcare professionals to make treatment decisions.

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