Everyone’s different: a qualitative study of patient perspectives on receiving information about methotrexate from rheumatology nurses

Objectives Methotrexate is the anchor drug for rheumatoid arthritis (RA) but because of its risk/benefit profile needs careful education to ensure people take it safely. This study explores perspectives of people with RA receiving information provided by rheumatology nurses when starting Methotrexate, focusing on their needs, concerns and whether expectations matched their experiences. Methods Adults with RA participated in semi-structured qualitative interviews before and after receiving information when starting Methotrexate. Data was analysed using reflexive thematic analysis. Results Nineteen participants attending two rheumatology units in England shared their experiences of receiving information about Methotrexate treatment from a rheumatology nurse. An overarching theme described the desire to receive individualised care tailored to meet specific needs and concerns against experiences of standardised information. Many participants reported not having opportunities to discuss concerns about why they should take Methotrexate. Worries about side-effects and treatment-related harms were frequently unresolved. Recalling practical aspects of treatment, and timing of blood tests was often difficult. Knowing when Methotrexate should not be taken and acting on advice to seek medical help if unwell could be hard to understand. Lack of clarity about prescribing and monitoring added complexity and burden. Conclusion These findings provide insight into patient experiences, illustrating unmet information needs when starting Methotrexate to treat RA. People with RA wanted care to address their individual circumstances. A person-centred approach, providing tailored information addressing individual needs and concerns offers opportunities to increase patient satisfaction and information recall, leading to improved safety, treatment adherence and patient outcomes.