VIDEO: Utilizing shared decision-making in psoriatic arthritis

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Well, there are a multitude of factors including the patient's preferences for the type of treatment they're receiving. Do they prefer to have a subcutaneous or an infused medication? An oral medication? Do they prefer to have a medication that's used less frequently or more frequently? Of course, they're going to be very concerned about the efficacy of a potential treatment as well as learning about safety considerations. So the whole process of shared decision making is key here to sit with the patient and educate, not dictate, and come up with what it is that the patient is most interested in based on what you are educating them about.

Of course, cost is an issue and so there are certain considerations there. Medicare patients tend to have less cost associated with their therapies if they're given intravenous medications, for example and other factors related to insurance coverage of medications. Comorbidities are important, so if a patient happens to have a problem with elevated liver enzymes because they have a condition known as hepatic steatosis, or fatty liver which can occur in patients that are overweight then we want to think twice about using medications that may cause some liver toxicity. We also are very sensitive to patients who may have a proclivity towards serious infection, like recurrent sinusitis. So in that case, we would want to use a medication with less likelihood of causing serious infection. All of these things are important as we go through shared decision making with our patients.