Are We on the Same Page? A Cross-Sectional Study of Patient-Clinician Goal Concordance in Rheumatoid Arthritis

Objective: Patient-clinician goal concordance is associated with improved outcomes in certain chronic diseases, but not explored in rheumatoid arthritis (RA). We examined goal concordance, correlates of concordance, and the association of concordance with health outcomes. Methods: Adult RA patients seen ≥1 time in prior 12 months at one of two rheumatology clinics participated. Patients and their clinician independently ranked top three goals for RA treatment from eight options prior to a routine visit. Patients completed post-visit surveys on health, demographics, health literacy, and adherence. Goal concordance was defined as the patient’s #1 goal being among the clinician’s top three goals for that patient. Bivariable and multivariable logistic regression models were used to examine correlates of concordance. Results: Patients were 58% female, 16% Spanish-speaking, and 29% had limited health literacy. Among 204 patient-clinician dyads, 20% were goal-discordant. “Have less pain” was selected by both patient and clinician in 81% of dyads, followed by “have fewer problems doing daily activities” by 63%. Otherwise, clinicians prioritized avoiding side effects, while patients ranked improved sleep, fatigue, and mood. Longer disease duration was associated with discordance (median 13.3 years, IQR 5.2-20 among discordant vs. 7 years, IQR 4-14; p=0.039); higher depressive symptoms were associated with concordance (8.1% vs 24%, p=0.04). Goal concordance was associated with higher medication adherence (AOR 2.76, 95% CI 1.01-7.56). Conclusion: One in five patient-clinician dyads had discordant treatment goals. Goal concordance was associated with higher medication adherence. Studies to improve goal elicitation and communication of RA patients’ priorities are needed.