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Decisions which previously were taken by the health professional alone are nowadays resulting from a shared decision making process in which patients obtain information from different sources. How patients assess the risks and benefits regarding treatment for their condition, can differ from the assessment of health professionals. Message framing of the treatment regarding benefits and risks and evidence of the effect of the treatment are just a few of the variables that may influence the choice of the patient. Shared decision making can enhance the patients understanding of treatment options and heighten confidence to make that choice, which will improve satisfaction with the chosen treatment. However, anxiety and unfamiliarity with the disease (a lack of, or perhaps even poor information), as well as with the multitude of treatment alternatives, are issues that should not be ignored. The patient perspective on the perception of benefits and risks and the trade-offs between those will be stressed. Personal experiences of situations in which benefit-risk decisions were important (in research as well as in clinical practice), will be highlighted and differences of risks (disease vs. non-disease related risks) as well as the possibility of prevention of risks will be explained. Effective communication regarding benefits and risks is essential for the patient in order to make a balanced choice and obtain better health outcomes. This presentation will assist in understanding the decision making process of patients, who have to face the actual day-to-day consequences of those decisions. Disclosure of Interest None Declared

Background Although participation in paid work is an important life area for patients and loss of work might have severe consequences for the physical, emotional and financial situation of patients, no recommendations for the assessment of work ability exist in rheumatology practice. Objectives To explore whether rheumatologists and rheumatology nurses a) consider worker participation as a treatment target and b) need tools to improve attention and care for participation in paid work. Methods Two comparable web-based surveys were developed and disseminated among rheumatologists and rheumatology nurses in the Netherlands. The questionnaires focussed on (a) existing practice in assessment of work ability of the patients, (b) priorities for different treatment targets (including work) and confidence with treatment plans, to be scored on a 0/no priority-10/highest priority scale, (c) need to have a standardized tool to address problems at work and (d) possible barriers to apply such tool. Results From the health care providers, 104 rheumatologists (40%) and 103 nurses (50%) in the Netherlands filled in the survey. 97% of the rheumatologists and 99% of the nurses considered optimal worker participation a treatment target. Rheumatologists prioritised the topic, mean (SD) 7.6 (1.3) after reducing disease activity 9.4 (0.9), pain 8.9 (1.2), and improving self-management 8.3 (1.2). Nurses also prioritised the topic 7.8 (1.2) after reducing disease activity 9.3 (0.9), pain 9.2 (1.0) and improving self-management 8.4 (1.2) but in addition considered reducing fatigue (8.4 (1.3) more important. Both groups acknowledge the importance of work participation but the gap between priority and confidence with treatment plans, 1.5 (1.4) and 2.2 (2.4) for rheumatologists and nurses respectively, shows that support may be necessary. Both rheumatologists and nurses considered a tool to assess problems at work and effective interventions important and necessary but effects should be examined. Of the rheumatologists, 52 % limitations in time a barrier for an active approach in daily practice and 28% referred their patients with problems regarding work participation to the rheumatology nurse. Conclusions The study showed that rheumatologists and nurses consider worker participation as an important treatment target. However, they express a need for (evidence based) tools to identify patients that are at risk for adverse work outcome and for better insight into effective interventions to improve the quality of care regarding work. Acknowledgements We thank Mr. R Buijs for the data analysis Disclosure of Interest C. W. J. Logtenberg- Rutten Grant/research support from: Abbvie, Y. J. van Eijk- Hustings Grant/research support from: Abbvie, E. Stadermann Employee of: Abbvie, M. J. Scholte- Voshaar Grant/research support from: Abbvie, M. M. Hazes Grant/research support from: Abbvie, A. E. Boonen Grant/research support from: Abbvie