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Abstract：
BACKGROUND: There is increasing research interest in the development of preventive treatment for individuals at risk of rheumatoid arthritis (RA). Previous studies have explored the perceptions of at-risk groups and patients about predictive and preventive strategies for RA, but little is known about health care professionals\' (HCPs) perspectives.
METHODS: One-to-one semi-structured qualitative interviews were conducted (face-to-face or by telephone) with HCPs. Audio recordings of the interviews were transcribed, and the data were analysed by thematic analysis.
RESULTS: Nineteen HCPs (11 female) were interviewed, including ten GPs, six rheumatologists and three rheumatology nurse specialists. The thematic analysis identified four organising themes: 1) Attributes of predictive and preventive approaches; 2) Ethical and psychological concerns; 3) Implementation issues and 4) Learning from management of other conditions. Theme 1 described necessary attributes of predictive and preventive approaches, including the type and performance of predictive tools, the need for a sound evidence base and consideration of risks and benefits associated with preventive treatment. Theme 2 described the ethical and psycho-social concerns that interviewees raised, including the potential negative economic, financial and psychological effects of risk disclosure for \'at-risk\' individuals, uncertainty around the development of RA and the potential for benefit associated with the treatments being considered. Theme 3 describes the implementation issues considered, including knowledge and training needs, costs and resource implications of implementing predictive and preventive approaches, the role of different types of HCPs, guidelines and tools needed, and patient characteristics relating to the appropriateness of preventive treatments. Theme 4 describes lessons that could be learned from interviewees\' experiences of prediction and prevention in other disease areas, including how preventive treatment is prescribed, existing guidelines and tools for other diseases and issues relating to risk communication.
CONCLUSIONS: For successful implementation of predictive and preventative approaches in RA, HCPs need appropriate training about use and interpretation of predictive tools, communication of results to at-risk individuals, and options for intervention. Evidence of cost-efficiency, appropriate resource allocation, adaptation of official guidelines and careful consideration of the at-risk individuals\' psycho-social needs are also needed.
METHODS: One-to-one semi-structured qualitative interviews were conducted (face-to-face or by telephone) with HCPs. Audio recordings of the interviews were transcribed, and the data were analysed by thematic analysis.
RESULTS: Nineteen HCPs (11 female) were interviewed, including ten GPs, six rheumatologists and three rheumatology nurse specialists. The thematic analysis identified four organising themes: 1) Attributes of predictive and preventive approaches; 2) Ethical and psychological concerns; 3) Implementation issues and 4) Learning from management of other conditions. Theme 1 described necessary attributes of predictive and preventive approaches, including the type and performance of predictive tools, the need for a sound evidence base and consideration of risks and benefits associated with preventive treatment. Theme 2 described the ethical and psycho-social concerns that interviewees raised, including the potential negative economic, financial and psychological effects of risk disclosure for \'at-risk\' individuals, uncertainty around the development of RA and the potential for benefit associated with the treatments being considered. Theme 3 describes the implementation issues considered, including knowledge and training needs, costs and resource implications of implementing predictive and preventive approaches, the role of different types of HCPs, guidelines and tools needed, and patient characteristics relating to the appropriateness of preventive treatments. Theme 4 describes lessons that could be learned from interviewees\' experiences of prediction and prevention in other disease areas, including how preventive treatment is prescribed, existing guidelines and tools for other diseases and issues relating to risk communication.
CONCLUSIONS: For successful implementation of predictive and preventative approaches in RA, HCPs need appropriate training about use and interpretation of predictive tools, communication of results to at-risk individuals, and options for intervention. Evidence of cost-efficiency, appropriate resource allocation, adaptation of official guidelines and careful consideration of the at-risk individuals\' psycho-social needs are also needed.
摘要：
背景：对于有类风湿性关节炎（RA）风险的个体开发预防性治疗的研究兴趣日益增加。以前的研究已经探索了高危人群和患者对RA的预测和预防策略的看法，但对医疗保健专业人员(HCP)的观点知之甚少。
方法：与HCP进行一对一的半结构化定性访谈（面对面或通过电话）。采访的录音被转录，并对数据进行专题分析。
结果：采访了19位HCPs（11位女性），包括十个GP,六名风湿病学家和三名风湿病学护士专家。主题分析确定了四个组织主题：1）预测和预防方法的属性；2）道德和心理问题；3）实施问题和4）从其他条件的管理中学习。主题1描述了预测和预防方法的必要属性，包括预测工具的类型和性能，需要一个健全的证据基础，并考虑与预防性治疗相关的风险和益处。主题2描述了受访者提出的道德和心理社会问题，包括潜在的负面经济，风险披露对“有风险”个人的财务和心理影响，RA发展的不确定性以及与正在考虑的治疗相关的潜在获益。主题3描述了所考虑的实施问题，包括知识和培训需求，实施预测和预防方法的成本和资源影响，不同类型的HCPs的作用，需要的指导方针和工具，以及与预防性治疗的适当性有关的患者特征。主题4描述了从受访者在其他疾病领域的预测和预防经验中可以学到的教训，包括如何规定预防性治疗，其他疾病和与风险沟通有关的问题的现有准则和工具。
结论：为了在RA中成功实施预测性和预防性方法，HCP需要对预测工具的使用和解释进行适当的培训，将结果传达给有风险的个人，以及干预的选择。成本效益的证据，适当的资源分配，还需要调整官方指导方针，并仔细考虑高危人群的心理社会需求。
方法：与HCP进行一对一的半结构化定性访谈（面对面或通过电话）。采访的录音被转录，并对数据进行专题分析。
结果：采访了19位HCPs（11位女性），包括十个GP,六名风湿病学家和三名风湿病学护士专家。主题分析确定了四个组织主题：1）预测和预防方法的属性；2）道德和心理问题；3）实施问题和4）从其他条件的管理中学习。主题1描述了预测和预防方法的必要属性，包括预测工具的类型和性能，需要一个健全的证据基础，并考虑与预防性治疗相关的风险和益处。主题2描述了受访者提出的道德和心理社会问题，包括潜在的负面经济，风险披露对“有风险”个人的财务和心理影响，RA发展的不确定性以及与正在考虑的治疗相关的潜在获益。主题3描述了所考虑的实施问题，包括知识和培训需求，实施预测和预防方法的成本和资源影响，不同类型的HCPs的作用，需要的指导方针和工具，以及与预防性治疗的适当性有关的患者特征。主题4描述了从受访者在其他疾病领域的预测和预防经验中可以学到的教训，包括如何规定预防性治疗，其他疾病和与风险沟通有关的问题的现有准则和工具。
结论：为了在RA中成功实施预测性和预防性方法，HCP需要对预测工具的使用和解释进行适当的培训，将结果传达给有风险的个人，以及干预的选择。成本效益的证据，适当的资源分配，还需要调整官方指导方针，并仔细考虑高危人群的心理社会需求。
