LAUSR

Physician-patient discrepancy in the goals of treatment remains an issue in axial spondyloarthritis (AxSpA). The National Axial Spondyloarthritis Society (NASS) has recently launched a national survey on patient values. Bridging the gap and improving alignment of physician-patient goals may lead to better outcomes. The objectives of this study were to investigate what patients wanted to discuss prior to their clinic attendance and to explore if these topics were discussed by the physician. The discrepancies between patient and physician goals were reviewed and steps put in place to bridge this gap. Patients fulfilled the ASAS criteria for AxSpA. At baseline 130 consecutive patients attending the AxSpA clinic between April to December 2021 were sent a pre-clinic questionnaire. Patients were asked 2 questions and these were: 1) What do you wish to discuss at your appointment? 2) What goals do wish to achieve following treatment? Questionnaires were collected prior to the clinic. The medical notes and clinic letters were then reviewed post-clinic to check if questions 1 and 2 were discussed. The patient demographics and disease activity scores BASMI, BASFI and BASDAI were also collected. At baseline, 100/130 (77%) patients returned the questionnaire prior to clinic. The mean age was 41 years (range 23-67). 74 patients (74%) were male and 80 patients (80%) were in work. Patients were seen by a doctor (38%), specialist nurse (32%) and physiotherapist (30%). In terms of treatment, patients were currently on biologics (64%), NSAIDs (46%) and DMARDs (30%). The mean BASMI was 1.6 (range 0.2-5.4), BASFI 2.7 (0-9.2), BASDAI 3.5 (0.2-8.6) and CRP 3 (0-20). For pre-clinic question 1, the top three topics were medication, pain management and progression of disease. For question 2, the top three topics were to be pain-free, maintain flexibility and being mobile and active. There were also other topics that were raised including fatigue, sleep, infections and family planning. Post clinic, the topics in question 1 were discussed directly by the physician in 73% and question 2 in 59% of cases. The topics that were most discussed in clinic were medication, exercise and pain. Pooling the topics, the top five themes were pain, medication, flexibility, exercise and disease progression. A limitation is that the post clinic analysis was based on written clinic notes and letters. This study confirms a degree of discordance in patient and physician goals. To bridge this gap, we are now focused on the top topics that patients wish to discuss in clinic and what they hope to achieve from their treatment. We have updated our AxSpA pathway to include these topics. Understanding patient goals will help us develop the content for the interventions and educational programmes to improve alignment and clinical outcomes. Disclosure A. Chan: None. A. Suarez: None. K. Rigler: None. J. Hamilton: None.