Recent years have witnessed substantial progress in the development of novel therapies for immunologic disorders such as rheumatoid arthritis (RA). Much of this progress has come from clinical research trials. While there is tremendous excitement surrounding new therapeutic approaches to RA a number of key questions relevant to their optimal use remain unanswered. For example, because many of these approaches are new, and have been assessed mainly in clinical trials, the potential for both long-term benefit and safety have not yet been defined. Because the approach to the treatment of RA is rapidly evolving, patients with RA may be confronted with a large and potentially confusing array of therapeutic options. At present, little is known about the processes by which RA patients make decisions concerning their therapy. Even in clinical trials that require informed consent, areas of concern and expectation that might affect patients' decision processes have not been explored. Moreover, it has been suggested that patients enrolling in clinical trials might inadequately represent the overall population of RA patients. For example, patients in trials may be better educated and from higher socioeconomic situations than RA patients in general. This has key implications for generalizing the results of trials to the broader population of RA patients. As the treatment of RA has rapidly progressed, access to or willingness to participate in clinical trials has become a more important consideration. In RA, it has been demonstrated that factors such as education and race can substantially impact outcome. Outside of rheumatology, it has been shown that ethnic background may affect patients decisions to pursue suboptimal therapeutic interventions as understanding related to the treatment of their rheumatic diseases. This project will utilize the technique of decision analysis to explore the factors that affect patients' choice of therapies. By including a diverse group of patients and assessing characterisitcs related to both the patient as well as the disease process, we hope to gain an understanding that should facilitate access of RA patients diverse in race, sex, gender and social status to optimal therapies for their disease.
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