{"doi":"10.1002/msc.1689","title":"“You can't touch, you can't bond”: Exploring COVID‐19 pandemic impacts on rheumatoid arthritis patient goals and communication with clinicians","abstract":"The rapid shift to telehealth during the COVID-19 pandemic changed how patients and clinicians interact and communicate (Srinivasan et al., 2020). Effective patient-clinician communication is essential to support shared decision making (SDM) around treatment goals. Goal concordance (or agreement) between patients and clinicians is associated with improved outcomes in chronic disease management (Heisler et al., 2003; Lafata et al., 2013) and increased medication adherence among patients with rheumatoid arthritis (RA) (Barton, Markwardt et al., 2021). Despite calls for SDM in the management of RA patients, communication is often suboptimal (Barton, Imoden et al., 2010; Barton, Markwardt et al., 2021) and patient and clinician goals can vary widely (Hulen et al., 2017). A recent study found that one in five patient-clinician dyads is discordant around the RA patient's number one goal for treatment. In the immediate phase of the pandemic, many outpatient visits for RA patients shifted from clinic to phone or video visits (George et al., 2021). Clinic staff and clinicians rapidly reorganised to minimise disruptions in care. While telehealth for RA patients during the pandemic may not be associated with variation in patient-reported outcomes like pain and general health (Gomez et al., 2021), its impacts on communication around goal concordance and SDM remain unexplored. Therefore, in this study, we examined the impacts of the pandemic and care delivery via telehealth on patient goals, patient-clinician goal communication, and management of RA using a mixed methods approach. This mixed methods study included a one-time survey of RA patients and a focus group with rheumatologists. The study was approved by the VA/OHSU Joint IRB (# e15851). Patients with RA who had a telehealth visit between March 1 and 31 July 2020 (university and Veterans Affairs patients) were invited to participate in a one-time survey via mail or phone. Rheumatology clinicians from the same university and Veterans Affairs sites were invited via email to participate in a 60-min focus group facilitated by the lead author. Patient study participants received a gift card for completion of study activities. Patient survey questions included demographics, health status, COVID-19 impacts, treatment goals, stress, communication, and optional free-text comments. Additionally, the survey measured resiliency using the Brief Resilience Scale (BRS) (Smith et al., 2008), decisional conflict, and clinician empathy using the Consultation and Relational Empathy (CARE) measure (Mercer et al., 2004). A semi-structured guide was used to direct the clinician focus group. Topics included telehealth and technology, patient treatment goals, and telehealth use. Examples of specific questions included: “What challenges did you face when using telehealth?”; “How often would your goals and your patients' goals align?”; “What was your initial reaction when you learnt that you would likely be using telehealth more often?”; and “Does the use of telehealth appear to affect your patients' communication with you?” Descriptive and bivariate analyses were conducted on survey items and qualitative content analysis was performed on free-text comments. Bivariate analyses were conducted, stratified by stress levels caused by the pandemic (moderate—high stress vs. little—no stress caused by the pandemic). Survey analyses were performed using Microsoft Excel. The transcript from the clinician focus group was analysed by a member of the research team (EH) using a framework matrix, which is a theme-based approach for pragmatic qualitative analysis (Averill, 2002). Of the 159 eligible patients invited to participate, 59 (37%) completed the survey. Patients were 71% male, 86% white, 85% Veterans, and 22% with limited health literacy. The average age of patients was 69 ± 10.5 years. Most patients (66%) ranked having less pain as their first goal followed by having fewer problems doing daily activities (34%) an","journal":"Musculoskeletal Care","year":2022,"id":311247,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9479,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":245941,"name":"Christopher P. Larsen","orcid":"0000-0002-7175-0242","position":1,"is_corresponding":false},{"id":1007870,"name":"Rachel Matsumoto","orcid":null,"position":2,"is_corresponding":false},{"id":286167,"name":"Patricia Katz","orcid":"0000-0002-8146-2519","position":3,"is_corresponding":false},{"id":516621,"name":"Jennifer L. Barton","orcid":"0000-0002-6771-3465","position":4,"is_corresponding":false},{"id":1007482,"name":"Elizabeth Hulen","orcid":"0000-0002-7681-4719","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T00:33:28.480200Z","pmid":"36073563","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}