Perceived Necessity vs Implementation of Psychological Support for Patients With RA in Japan

Psychological support and patient-centered care (PCC) have been linked to treatment outcomes for patients with rheumatoid arthritis (RA). In a recent study coming from the International Journal of Rheumatic Diseases, researchers investigated nurse opinions and practices of psychological support and PCC for patients with RA.

RA is a chronic, autoimmune, inflammatory disease that largely affects the joints; over time it is affiliated with joint damage and possible disability in those affected. Aside from the physical effects, anxiety and depression are common comorbidities accompanying RA and up to 70% and 66%, respectively, of patients diagnosed with RA are affected by these symptoms. Psychological factors such as these have been linked to poor adherence during treatment and, as a result, clinical practices are witnessing many patients with RA experiencing difficulties meeting their treatment goals.

The authors cite previous reports indicating that nurse-led patient-centered care contributes to improved psychological states, quality of life and overall wellbeing of patients with RA. Nurses are considered essential in this process because patients often confide in their nurses to express their anxieties.

This study recruited registered nurses in Japan with experience in rheumatic care who participated in a nationwide rheumatology nurse workshop in 2017. The nurses completed a questionnaire about their perceptions on the necessities, motivations, and applications of psychological support and PCC. Questions also surveyed the understanding of the five psychological support concepts of listening, acceptance, empathy, open-ended questions and close-ended questions. Additionally, they were asked to provide individual responses about any reasoning for not giving psychological support. Answers were registered on the 7-point Likert scale, which scales the importance of PCC aspects from 1 (not at all) to 7 (extremely).

Fifty-three nurses participated in this study (52 female, 1 male), with a median age of 46, clinical experience of 21 years and seven years of experience in rheumatic care. Every participant was a registered nurse, 36 of which held rheumatology care nursing licenses.

The nurses rated the perceived necessity of providing psychological support highly (median 7, IQR 6-7); however, implementation of this support was statically significantly lower (median 5, IQR 4-6) than necessity and motivation (median 6.5, IQR 6-7; P < .0001 for both). Issues regarding time in their busy schedules, insufficient knowledge, frequent staff reallocating, and limited space were cited as reasons they could not provide psychological support to patients.

Regarding the timing of perceived necessity and implementation, 92% rated support as necessary to give “whenever patients require it”; however, only 64% reported implementing this support. In specific scenarios where psychological support was considered necessary, the highest-rated instance was at the start of a biologic (85%), followed by the start of medication (75%), the time of diagnosis (74%), and then when changing a biologic (72%). Taking this into consideration, the authors noted another study’s findings that demonstrated patient anxiety is typically highest when they are diagnosed.

The perceived necessity and implementation of PCC was also high like that of psychological support; however, similarly, implementation of this practice was statistically significantly lower than necessity in each of these areas: informing patients of their access to consult with nurses (6 [5-7] vs. 7 [7], P = .00054), giving support specific to patients' perspectives (5 [4-6] vs. 7 [6-7], P < .0001), giving support to patients' families (5 [4-6] vs. 7 [6.5-7], P < .0001), referring patients to other health professionals (6 [5-6.5] vs. 7 [6.5-7], P < .0001), catering support to patients' feelings (6 [4.75-6] vs. 7 [7], P < .0001), and giving support based on patients' needs (5 [4.75-6] vs. 7 [6.25-7], P < .0001).

Overall, there was a positive correlation between the implementation of psychological support and the entirety of PCC previously mentioned.

The authors noted several limitations to their study, including a small sample-size, gender distribution bias, and the quantitative methodology of their questionnaire that limited their ability to ask follow-up questions and gather more detailed information on nurse opinions, perceptions.

The study concludes that “the understanding and implementation of psychological support are important to promote PCC.” Researchers mention previous findings that show how psychological support influenced better communication, established trust, limited anxiety, and overall helped patients cope with their illness and feel more motivated towards their treatment. To face these issues in clinical practice and improve patient care and quality of life “it is necessary to establish an education system for nurses that helps them acquire knowledge and skills of psychological support.”

Reference

Fusama M, Motonaga T, Kuroe Y, Nakahara H. Psychological support and patient-centered care for patients with rheumatoid arthritis: Nurses' opinions and practice in Japan. Int J Rheum Dis. 2023;00:1-9. doi:10.1111/1756-185X.14828