Patient and health professional views on risk-stratified monitoring of immune-suppressing treatment in adults with inflammatory diseases

Fuller, Amy; Hancox, Jennie; Williams, Hywel C; Card, Tim; Taal, Maarten W; Aithal, Guruprasad P; Fox, Christopher P; Mallen, Christian D; Maxwell, James R; Bingham, Sarah; Vedhara, Kavita; Abhishek, Abhishek

Abstract

Objective
To explore the acceptability of an individualised risk-stratified approach to monitoring for target-organ toxicity in adult patients with immune-mediated inflammatory diseases established on immune-suppressing treatment(s).

Methods
Adults (≥18 years) taking immune-suppressing treatment(s) for at-least six months, and healthcare professionals (HCPs) with experience of either prescribing and/or monitoring immune-suppressing drugs were invited to participate in a single, remote, one-to-one, semi-structured interview. Interviews were conducted by a trained qualitative researcher and explored their views and experiences of current monitoring and acceptability of a proposed risk-stratified monitoring plan. Interviews were transcribed verbatim and inductively analysed using thematic analysis in NVivo.

Results
Eighteen patients and 13 HCPs were interviewed. While participants found monitoring of immune-suppressing drugs with frequent blood-tests reassuring, the current frequency of these was considered burdensome by patients and HCPs alike, and to be a superfluous use of healthcare resources. Given abnormalities rarely arose during long-term treatment, most felt that monitoring blood-tests were not needed as often. Patients and HCPs found it acceptable to increase the interval between monitoring blood-tests from three-monthly to six-monthly or annually depending on the patients’ risk profiles. Conditions of accepting such a change included: allowing for clinician and patient autonomy in determining an individuals’ frequency of monitoring blood-tests, the flexibility to change monitoring frequency if someone’s risk profile changed, and endorsement from specialist societies and healthcare providers such as the National Health Service.

Conclusion
A risk-stratified approach to monitoring was acceptable to patients and HCPs. Guideline groups should consider these findings when recommending blood-test monitoring intervals.

Citation

Fuller, A., Hancox, J., Williams, H. C., Card, T., Taal, M. W., Aithal, G. P., Fox, C. P., Mallen, C. D., Maxwell, J. R., Bingham, S., Vedhara, K., & Abhishek, A. (in press). Patient and health professional views on risk-stratified monitoring of immune-suppressing treatment in adults with inflammatory diseases. Rheumatology, Article keae175. https://doi.org/10.1093/rheumatology/keae175

• Journal Article Type: Article
• Acceptance Date: Mar 12, 2024
• Online Publication Date: Mar 14, 2024
• Deposit Date: Mar 21, 2024
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Article Number: keae175
• DOI: https://doi.org/10.1093/rheumatology/keae175
• Keywords: Pharmacology (medical); Rheumatology
• Public URL: https://nottingham-repository.worktribe.com/output/32749610
• Publisher URL: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keae175/7628623?