Changing mindsets about methotrexate in the rheumatology clinic to reduce side effects and improve adherence
A Randomized Controlled Trial
Bibliographic Data
| ID | 7146744 |
|---|---|
| Authors | Rachael Yielder (0000-0002-1644-1762, University of Auckland), Kari Leibowitz (0000-0001-7494-7270, Stanford University), Alia J Crum (0000-0002-0892-1811, Stanford University), Paul Manley (Te Whatu Ora Health, Te Toka Tumai Auckland , Auckland 1023), Nicola Dalbeth (0000-0003-4632-4476, University of Auckland), Keith J Petrie (0000-0002-6337-2480, University of Auckland) |
| Year | 2025 |
| Volume | 59 |
| Issue | 1 |
| Publication date | 2025-01-04 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Annals of Behavioral Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0883-6612 • E-ISSN: 1532-4796 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/abm/kaae089 |
| PMID | 39715363 |
| OpenAlex | W4405717508 |
| Language | EN |
| References cited | 38 |
BACKGROUND: Patients' negative expectations about medication can exacerbate side effect burden leading to low adherence and persistence. A novel intervention involves targeting mindsets about non-severe symptoms; reframing them as encouraging signs of medication working. PURPOSE: This study aimed to assess whether a brief symptom-mindset intervention can improve symptom experience and adherence in patients starting methotrexate to treat an inflammatory rheumatic disease. METHODS: A randomized controlled trial was conducted with patients starting methotrexate. Participants were randomly assigned (1:1) to a mindset intervention or standard information control condition. Symptom mindset was assessed after 4 weeks to check intervention efficacy. The primary outcome was symptom experience after 4 weeks. Secondary outcomes were adherence and motivation to take methotrexate (4 weeks), as well as continuation and C-reactive protein (12 weeks). RESULTS: Forty-seven participants were randomly assigned to the intervention (n = 24) or control group (n = 23). All participants completed the study. After 4 weeks, compared to the control group, intervention participants endorsed more positive symptom mindsets, experienced less symptom burden (mean difference -2.70 [95% CI, -4.50, -0.90] P = .005), fewer general symptoms (3.53 [-6.99, .79] P = .045) and a similar number of methotrexate-specific symptoms (-0.79 [-2.29, 0.71] P = .295). The intervention group had better motivation and adherence to methotrexate at 4 weeks and better continuation, and C-reactive protein at 12 weeks than the control group. There was no difference in side effect attribution. CONCLUSIONS: In patients starting methotrexate, a mindset intervention reframing the role of non-severe side effects is a promising approach for improving symptom experience and early stage medication persistence.
Cognitive reframing · Health psychology · Intervention (counseling) · Methotrexate · Mindset · Physical therapy · Psychiatry · Public health · Randomized controlled trial · Internal Medicine · Medication Adherence and Compliance · Medicine · Nursing · Patient-Provider Communication in Healthcare · Psychology · Rheumatoid Arthritis Research and Therapies · Rheumatology
| Citation velocity | historical |
|---|---|
| Highly cited | No |