Patients can now access concise information and are empowered to have more autonomy to manage gout as doctor-patient communication strengthens.

With greater global affluence and the increased consumption of red meat, soft drinks and alcohol, incidences of gout have been on the rise over the years. More than four per cent of adults in Singapore suffer from this complex form of arthritis, which causes severe pain, swelling, redness and tenderness in the joints.

“Despite this rising trend, treatment is not optimised. In a study done by SingHealth Polyclinics (SHP), only 50 per cent of the patients with frequent acute gout attacks were on allopurinol, which is usually the first line of treatment for long-term gout control,” said Dr Meykkumar S/O Meyappan, Associate Consultant, SHP. Patients were also found to have a poor understanding of treatment options.

<< SingHealth Polyclinics found that patients were afraid to start treatment for gout due to the perceived high rate of side effects, says Dr Meykkumar S/O Meyappan. >>

Shared decision-making 

To empower patients to better manage their condition, SHP has developed an information kit, or Patient Decision Aid (PDA), about gout and its treatment options in a clear and concise manner.

It includes a simple infographic comparing treatment options in terms of efficacy, cost and side effects, which sets out the risk of developing rashes, headaches, diarrhoea, vomiting, or kidney and liver issues. It also clearly shows patients the effects of non-treatment or dietary control so that they can weigh their risks when considering these options.

Co-developed by patients and a multidisciplinary medical team through in-depth one-to-one interviews and focus group discussions, this PDA is designed to be used by SHP primary care physicians during consultation with patients.

It helps physicians better understand patients’ priorities and concerns, thereby advising them of the most suitable course of treatment. It also enables physicians to easily identify and address any misperceptions patients may have about various treatments, effectiveness and side effects.

<< A glimpse of an information kit, or Patient Decision Aid, about gout and its treatment options developed by SingHealth Polyclinics. >>

One of the benefits of this PDA is that it enables a shift towards a shared decisionmaking process, where patients get to decide on their own treatment option while getting professional advice from doctors. This is a departure from the traditional model, where doctors would usually prescribe treatments.

“The patient is thus more informed and involved in the decision, takes greater ownership over his own health, and better understands the implications of the decision,” said Dr Meykkumar.

Read more: Click here for foods to avoid which trigger gout attacks and best foods to eat.

Common misconceptions

“A study by SHP found that patients were afraid to start treatment due to the perceived high rate of side effects and their fear of being on long-term medications. Most patients also feel better after the acute attacks subside with painkillers, and do not see the need to start medications when they feel well,” he said.

Unfortunately, simply relying on a short course of painkillers for pain relief may end up perpetuating the cycle of attacks, especially if gout is poorly controlled.

Indeed, many patients are not aware of the long-term complications of gout and its impact on their quality of life. If gout is not controlled with diet or medication, recurring gout attacks may damage the joint permanently. Patients may develop deposits around the joint called tophi, which further restrict joint movement. They may also develop kidney stones easily.

Non-adherence is another common issue. “We believe that shared decision-making will improve poor adherence towards gout treatment. This approach focuses on the patients’ autonomy so that they will be more willing to accept the treatment because the doctor has taken their lifestyles and concerns into consideration,” said Clinical Associate Professor Tan Ngiap Chuan, Director of Research, SHP, and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme.

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