Development and evaluation of a patient-centred decision aid to support shared decision-making for selecting targeted therapies in rheumatic diseases: a development and usability study

The growing availability of targeted therapies has made shared decision-making essential to align treatment options with patient values and preferences. We aimed to develop a patient-centred decision aid (DA) to support patients with rheumatic diseases and healthcare providers in selecting appropriate therapies. Following the International Patient Decision Aid Standards (IPDAS), we used a systematic approach to develop the DA. Scope and design were defined collaboratively with rheumatologists, specialist nurses, researchers, and patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The prototype presented rheumatic disease information, treatment options, and their risks and benefits. Usability was evaluated in 20 patients (10 RA; 10 AS) using structured questionnaires and the Decisional Conflict Scale (DCS). Participants rated clarity, information sufficiency, layout, and decision confidence on a 5-point Likert scale. The DA delivered clear, accessible information on targeted therapies, using visual aids and plain language to aid understanding. Usability testing indicated high satisfaction. More than 90% of participants found the DA easy to read and useful for discussing treatment options with clinicians. In exploratory analyses, median DCS scores decreased after DA use, in both RA (48.4 to 21.9; P = 0.008) and AS (43.0 to 20.3; P = 0.006) groups. The DA is a user-friendly, evidence-based tool developed and evaluated according to IPDAS. The DA showed high acceptability among patients and healthcare professionals and supported shared decision-making for patients initiating targeted therapies for RA and AS. Exploratory findings also suggested lower decisional conflict scores after DA use.