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Fronek L, Davis MJ, Greenway HT, Kelley B. Shared decision making for perioperative antibiotic use during Mohs micrographic surgery on the lower extremities. JAAD Int 2024; 16:155-162. [PMID: 39006918 PMCID: PMC11245999 DOI: 10.1016/j.jdin.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 07/16/2024] Open
Abstract
Background While there is a higher risk of surgical site infection (SSI) on the lower extremities following Mohs micrographic surgery (MMS), antibiotic prophylaxis (AP) is debated. Objective To determine the role of shared decision making (SDM) in guiding AP usage during MMS on the lower extremities. Materials and methods A prospective observational study was conducted whereby patients received a standardized SDM discussion or routine counseling. Patient satisfaction quantified by the shared decision-making questionnaire (SDMQ9) survey, rate of SSI, and rate of AP prescription were recorded. Results In total, 51 patients were included. While there were less antibiotics prescribed in the treatment group (20% versus 50%, P = .025), this did not affect incidence of SSI (8% in treatment group versus 7.7% in control group, P = .668). Patient satisfaction was statistically greater in SDM group (4.73 versus 2.18 in control (P < .001). Conclusion Patient satisfaction scores were higher among the patients who received SDM. While the usage of AP was lower in the SDM group, this did not affect incidence of SSI. This study allows the opportunity to apply SDM in the setting of MMS, which to our knowledge has not yet been attempted in the field of dermatologic surgery.
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Affiliation(s)
- Lisa Fronek
- Department of Dermatology, Scripps Clinic Torrey Pines Bighorn Mohs Surgery and Dermatology, San Diego, California
| | - Michael J Davis
- Department of Dermatology, Memorial Sloan Kettering, Mohs Micrographic Surgery, New York, New York
| | - Hubert T Greenway
- Department of Dermatology, Scripps Clinic Torrey Pines Bighorn Mohs Surgery and Dermatology, San Diego, California
| | - Benjamin Kelley
- Department of Dermatology, Scripps Clinic Torrey Pines Bighorn Mohs Surgery and Dermatology, San Diego, California
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Kwong BY. Improved Dermatologist, Patient, and Oncologist Collaboration Needed During Cancer Drug Development. JAMA Dermatol 2024; 160:597-599. [PMID: 38506833 DOI: 10.1001/jamadermatol.2024.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
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Catalan-Griffiths A, Pasquali P, Arias-Santiago S, Valeron P, Martinez-Lopez A, Negrin ML, Thuissard Vasallo IJ, Andreu-Vazquez C, Freites-Martinez A. Shared decision-making quality and decisional regret in patients with low-risk superficial basal cell carcinoma: A prospective, multicenter cohort study. JAAD Int 2023; 13:159-163. [PMID: 37823045 PMCID: PMC10562145 DOI: 10.1016/j.jdin.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 10/13/2023] Open
Abstract
Background Many therapies are available to treat low-risk superficial basal cell carcinoma (lr-sBCC), which may complicate the shared decision-making (SDM) process. Objective To assess the SDM process of patients and physicians when deciding lr-sBCC therapy as well as the factors that may influence the SDM process. Methods A prospective, multicenter cohort study was conducted over 18 months, from October 2018 to April 2020, in 3 tertiary university hospitals and 1 private hospital. Results This study included 107 patients. There was a weak positive correlation between Shared Decision-Making Questionnaire-Patient version (SDM-Q-9) and Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) (Spearman's correlation coefficient [rs] [105] = 0.21; P = .03). Most patients (71%) chose a nonsurgical treatment after the SDM process. Patients with higher satisfaction with the SDM had lower decisional conflict and decisional regret (P < .001). Patients aged >80 years had higher rates of significant decisional conflict. When evaluating treatment decisions, the highest median score for decisional conflict (22, IQR [16]; P = .01) was observed among patients who chose a surgical excision. Limitations Patients may have self-selected to participate. Conclusion This study suggests that some patients may prefer less invasive therapies for lr-sBCC. The SDM process may reduce decisional conflict and decisional regret.
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Affiliation(s)
- Andrea Catalan-Griffiths
- Dermatology Service, Medical University of Graz, Graz, Austria / AUVA Rehabilitation Clinic Tobelbad, Tobelbad, Austria
| | - Paola Pasquali
- Dermatology Service, Pius de Valls Hospital, Tarragona, Spain / Alcala University
| | - Salvador Arias-Santiago
- Dermatology Service, Virgen de las Nieves University Hospital, Granada, Spain
- Biosanitary Research Institute of Granada - ibs.GRANADA, Granada, Spain
| | - Pedro Valeron
- Dermatology Service, Dr Negrin University Hospital, Gran Canaria, Spain
| | | | | | | | | | - Azael Freites-Martinez
- Dermatology Service, Hospital Ruber Juan Bravo Hospital / Universidad Europea, Madrid, Spain
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Kingston P, Yee D, Huang MY, Korouri E, Peterson H, Lee K, Agüero R, Armstrong AW. Shared decision-making and satisfaction with care: a population-based study in patients with acne with skin of colour in the USA. Clin Exp Dermatol 2023; 48:1032-1035. [PMID: 37098265 DOI: 10.1093/ced/llad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/20/2023] [Indexed: 04/27/2023]
Abstract
Little is known about differences in shared decision-making and patient satisfaction with acne care among different ethnicities and races. We conducted a cross-sectional study to determine differences between patients with acne who are White and those with skin of colour (SOC), i.e. (i) engagement in shared decision-making, and (ii) patient satisfaction with care, using the 2009-2017 and 2019 Medical Panel Expenditure Survey. Patients with acne with SOC were nearly two times more likely to engage in high shared decision-making compared with White patients [adjusted odds ratio 1.80, 95% confidence interval (CI) 1.30-2.51, P < 0.001]. Patients with SOC with acne reported lower satisfaction with care compared with White patients (β = -0.38, 95% CI -0.69 to -0.06, P = 0.02). Patients with SOC who had acne reported higher levels of shared decision-making than White patients. However, compared with the White patients, patients with SOC report lower satisfaction with their care. There may be other factors contributing to lower satisfaction with care in patients with SOC who have acne.
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Affiliation(s)
| | - Danielle Yee
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Edwin Korouri
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, IL, USA
| | - Hannah Peterson
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kathryn Lee
- Saint Louis University School of Medicine, St Louis, MO, USA
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Han JJ, Manjaly P, Lee KJ, Kassamali B, Kus KJ, Pérez-Chada LM, Lachance A, Li SJ, Senna MM, Huang KP, Mostaghimi A. Physician values in alopecia areata treatment decision-making: A qualitative assessment. JAAD Int 2023; 11:14-23. [PMID: 36818678 PMCID: PMC9932109 DOI: 10.1016/j.jdin.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 01/01/2023] Open
Abstract
Background Alopecia areata (AA) is a disease of hair loss with multiple treatment options. Physicians play an important role in guiding patients during the decision-making process. Objective Assess physicians' values and attitudes when helping patients choose an AA treatment. Methods Semi-structured qualitative interviews were conducted with dermatologists of varying practice type and location. Each interview was coded independently twice using inductive thematic analysis. Interrater reliability and code frequencies were determined. Results Fourteen participants were interviewed. Interrater reliability was κ = 0.85 to 0.97. Dermatologists wanted patients to consider various treatment factors (ie, efficacy, safety, convenience of use, accessibility) and also assessed patients' AA clinical severity and personality traits. Participants often encountered various barriers to effective communication with patients, which may be mitigated by shared decision-making. Shared decision-making tools were perceived to potentially improve patient care and communication, although physicians expressed concern about lack of individualization, limitations of time, and the appropriateness of information. Conclusion AA treatment decision-making is a complex process that often utilizes the expertise of a dermatologist, during which shared decision-making tools may be of value to both patients and physicians.
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Affiliation(s)
- Jane J. Han
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Karen J. Lee
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard, Boston, Massachusetts
| | - Kylee J.B. Kus
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- William Beaumont School of Medicine, Oakland University, Auburn Hills, Michigan
| | | | - Avery Lachance
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maryanne M. Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathie P. Huang
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Correspondence to: Arash Mostaghimi, MD, MPA, MPH, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115.
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Foster E, Loiselle AR, Thibau IJ, Smith Begolka W. Factors facilitating shared decision making in eczema: Met and unmet needs from the patient perspective. JAAD Int 2023; 11:95-102. [PMID: 36941910 PMCID: PMC10023901 DOI: 10.1016/j.jdin.2022.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background Research has shown that eczema patients prefer some degree of shared control over treatment decisions, but little is known about factors perceived to be important to facilitate shared decision making (SDM). Objective To determine factors eczema patients and caregivers consider to be important for SDM, and how often they experience them with their eczema healthcare provider (HCP). Methods A cross-sectional survey study (64 questions) was conducted, which included factors related to SDM rated by respondents on a Likert scale for importance, and how often these factors were true with their current eczema HCP. Results Respondents (840, response rate 62.4%) most frequently rated their health literacy and communication skills as important for SDM. Factors which indicated a strong provider-patient relationship, and HCPs who initiate treatment conversations were also deemed beneficial. Low importance was placed on concordant HCP race/ethnicity, however, of those who did rate it as important, 53/91 identified as Black (half of all Black respondents). Limitations A high proportion of respondents were aware of the term SDM prior to the survey. Conclusions SDM is more likely to be facilitated when patient education and empowerment are coupled with HCPs who initiate treatment discussions, maintain compassion resilience, and listen to patient perspectives.
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Affiliation(s)
- Erin Foster
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Allison R. Loiselle
- National Eczema Association, Novato, California
- Correspondence to: Allison R. Loiselle, PhD, National Eczema Association, 505 San Marin Dr #B300, Novato, CA 94945.
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Reyes-Hadsall S, Drake L, Han JJ, Lee KJ, Zhou G, Mostaghimi A, Huang KP. Shared Decision-Making, Therapeutic Choice, and Decisional Regret in Patients With Alopecia Areata. JAMA Dermatol 2022; 158:1187-1191. [PMID: 35976667 PMCID: PMC9386608 DOI: 10.1001/jamadermatol.2022.3025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/04/2022] [Indexed: 11/14/2022]
Abstract
Importance Alopecia areata (AA) is an autoimmune disorder of hair loss with a complex and evolving treatment landscape, making it an ideal setting for shared decision-making (SDM) between patients and physicians. Given the varying efficacy, experience, and risks of treatments for AA, we sought to evaluate patient preferences for SDM and the association of SDM with decisional regret. Objective To evaluate patient preferences for SDM and the association of SDM with decisional regret. Design, Setting, and Participants A cross-sectional online survey using the validated SDMQ9 scale for shared decision-making and Decisional Regret Scale (DRS) was distributed using the National Alopecia Areata Foundation (NAAF) with the aim of assessing (1) patient preferences in SDM when making treatment decisions, (2) how patients perceived the last decision to have been made, (3) which components of SDM were incorporated into the last decision, and (4) decisional regret related to their last treatment decision. The survey was distributed from July 12, 2021, to August 2, 2021, and data analysis occurred from October 2021 to March 2022. Main Outcomes and Measures Primary outcomes included (1) patient preferences in incorporation of SDM, (2) how patients made their most recent treatment decision, (3) which components of SDM were incorporated into their most recent treatment decision measured with the validated SDMQ9, and (4) an assessment of decisional regret in relation to SDM components and the most recent treatment modality used by the patient as measured by the validated DRS. Results Of 1387 individuals who initiated the survey, 1074 completed it and were included in the analysis (77.4% completion rate). Overall, 917 respondents were women (85.4%). There were 5 American Indian or Alaska Native respondents (0.5%), 33 were Asian (3.1%), 112 Black or African American (10.4%), 836 White (77.8%), and 36 were multiracial (3.4%) or other (36 [3.4%]). The mean age (SD) was 49.3 (15.4) years. Most respondents preferred making the final treatment decision themselves after considering their physician's opinion (503 [46.8%]). Of those who preferred to make treatment decisions using SDM, most made the last AA treatment decision with their physician (596 [55%]; 95% CI, 53%-58%; P < .001). The components of SDM implemented by the patients' dermatologists most identified were the physician "explained the advantages and disadvantages of treatment options" (472 [44%]), and the physician "asked me which treatment option I prefer" (494 [45.9%]). Incorporation of SDM by physicians was generally associated with decreased decisional regret (all ORs with 95% CIs greater than 1.1; P < .01). The treatments associated with the lowest decisional regret were Janus kinase (JAK) inhibitors, followed by biologics, and deciding not to treat; whereas, the highest decisional regret was reported with anthralin and minoxidil. Conclusions and Relevance The findings of this cross-sectional survey study suggest that patients with AA prefer to make treatment decisions with their dermatologist using SDM. When SDM is used, patients report less decisional regret, indicating that SDM may help improve the patient-reported quality of treatment decisions. Newer, more efficacious therapies such as JAK inhibitors may be related to lower decisional regret. Future studies should seek to devise solutions to implement SDM as the AA treatment landscape continues to evolve.
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Affiliation(s)
- Sophia Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lara Drake
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Jane J. Han
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Karen J. Lee
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kathie P. Huang
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
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Ito Y, Ishikawa H, Suzuki A, Kato M. The relationship between evaluation of shared decision-making by pet owners and veterinarians and satisfaction with veterinary consultations. BMC Vet Res 2022; 18:296. [PMID: 35918681 PMCID: PMC9344613 DOI: 10.1186/s12917-022-03401-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Communication skills are a necessary competency in veterinary medicine, and shared decision-making (SDM) between practitioners and patients is becoming increasingly important in veterinary practice as in human medicine. There are few studies that have quantitatively measured SDM in veterinary health care, and the relationship between SDM and consultation satisfaction is unknown. The purpose of this study was to investigate the status of SDM implementation in veterinary hospitals and the relationship between SDM implementation and consultation satisfaction among pet owners. We conducted a cross-sectional study using self-administered questionnaires among pet owners and veterinarians. In total, 77 pet owners who visited a veterinary clinic and 14 veterinarians at the clinics participated in this study. After a veterinary clinic visit, owners were asked to rate their decision-making preferences using the Shared Decision Making Questionnaire for patients (SDM-Q-9) adapted for veterinary medicine, as well as their satisfaction with the consultation. The corresponding veterinarians were asked to complete the veterinary version of the survey (SDM-Q-Doc). Results Most pet owners (64.9%) preferred SDM in veterinary consultations. Cronbach's alpha coefficient of 0.84 for the veterinary SDM-Q-9 and 0.89 for the veterinary SDM-Q-Doc both confirmed high reliability. The Spearman's correlation coefficient between the SDM-Q-9 and consultation satisfaction was 0.526 (p < 0.001), which was significant. The SDM-Q-Doc was not significantly correlated with either the SDM-Q-9 or pet owner consultation satisfaction. We conducted a sensitivity analysis of correlations among veterinarians; responses on the SDM-Q-Doc to examine the association between the SDM-Q-Doc and SDM-Q-9 and owner satisfaction; the results remained the same and no association was found. Conclusions Our findings suggest that evaluation of SDM among pet owners was associated with their satisfaction with veterinary consultation. Veterinarians may be able to improve the satisfaction level of pet owners by adopting a consultation method that increases SDM. We did not consider the content of veterinary care or the number of visits to the veterinary clinic; future studies should be conducted to confirm the validity of our results.
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Affiliation(s)
- Yuma Ito
- Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hirono Ishikawa
- Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Asuka Suzuki
- Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mio Kato
- Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Hung CT, Chen YH, Hung TL, Chiang CP, Chen CY, Wang WM. Clinician-created educational video for shared decision-making in the outpatient management of acne. PLoS One 2022; 17:e0271100. [PMID: 35802643 PMCID: PMC9269380 DOI: 10.1371/journal.pone.0271100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Abstract
Shared decision-making (SDM) provides patient-centered care. However, the limited consultation time was the main factor hindering the application. Patient education is crucial in the process of SDM. The use of visual aids as health education materials is an effective way to improve patients’ health literacy and medication adherence. This study aimed to determine the effectiveness of the clinician-created educational video of acne, accessed by patients during the waiting time, including knowledge level and satisfaction. This study was conducted in dermatology outpatient clinics and collected patient responses through electronic devices. During the waiting time, patients with acne would read educational pamphlets and complete the test first. Then, a clinician-created 8-minute educational video, as a patient decision aid (PDA), was accessed by patients using their own mobile smart devices, followed by a test and questionnaire about the satisfaction of the pamphlet and video. We enrolled 50 patients with acne, including 33 males and 17 females. The mean age is 25.55 ± 6.27 years old, ranging from 15 to 47 years old. About the patients’ knowledge, the test score improved significantly after watching the video (P < .001). The same findings were observed in the subgroup analysis of gender and different age groups. A higher proportion of patients preferred the educational video over the pamphlet in both genders and different age groups. All patients agreed with the video helped them to understand the educational information and impressed them more than reading pamphlets. The application of clinician-created educational videos in patient education seems to be an efficient solution to implement SDM in the daily clinical work. Besides, we could remind patients to watch the video anytime when they were not sure about the treatment choices, side effects, or the precautions of medications.
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Affiliation(s)
- Chih-Tsung Hung
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of General Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Hsien Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of General Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Tzu-Ling Hung
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ping Chiang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Yu Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Vice Chairman, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Thibau IJ, Loiselle AR, Latour E, Foster E, Smith Begolka W. Past, Present, and Future Shared Decision-making Behavior Among Patients With Eczema and Caregivers. JAMA Dermatol 2022; 158:912-918. [PMID: 35793092 PMCID: PMC9260637 DOI: 10.1001/jamadermatol.2022.2441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Question What are the experiences, preferences, and motivators for shared decision-making (SDM) in patients with eczema? Findings In this survey study of 1313 patients with eczema and caregivers, higher degree of involvement in SDM was significantly associated with higher consultation satisfaction, and self-reported knowledge about the causes of eczema was associated with past and future SDM. Control of disease was inversely associated with past SDM behavior; motivating factors for patients to engage in SDM included the clinician welcoming the patient’s input, acknowledgment that patients are experts on their bodies, and whether treatment is working. Meaning Asking for patient perspectives and empowering patients and caregivers through education can encourage SDM and improve patient satisfaction with care. Importance Engaging in shared decision-making (SDM) can help patients understand and choose treatments according to their values and has been shown to improve patient satisfaction and adherence with treatment. It is well suited for conditions like eczema for which several medically appropriate treatment options exist. However, little is known about the use and experience of SDM in eczema. Objective To understand experiences, preferences, and expectations for SDM in eczema care settings from the patient and caregiver perspective. Design, Setting, and Participants The National Eczema Association conducted an online survey in January 2021 among self-selected patients and caregivers. Inclusion criteria (US resident, patient with eczema or caregiver of a patient with eczema aged ≤17 years, respondent age ≥18 years) were met by 1313 of 1387 respondents (94.7%). Data analysis was performed from May 2021 to November 2021. Main Outcomes and Measures Outcomes were past SDM (using a 9-item SDM questionnaire [SDMQ9]; score ranges transformed to 0-100), present SDM (Control Preferences Scale), and future SDM (self-reported confidence and motivation to engage in SDM) behavior. Results Among the 1313 respondents included in the study, most were female (1046 of 1313 [79.7%]) adult (1086 of 1313 [82.7%]) patients with a mean (SD) patient Recap of Atopic Eczema score of 11.7 (7.2), mean (SD) patient age of 39.5 (22.2) years, and mean (SD) SDMQ9 score of 65.1 (27.4). For present SDM, 479 of 966 (49.6%) reported “I prefer to make the final decision after seriously considering my doctor’s opinion,” and 655 of 955 (69.4%) reported being very or extremely confident to engage in SDM in the future. Those who reported feeling “very well informed” about the causes of eczema had a 14.7-point higher (95% CI, 9.2-20.2; P < .001, multiple linear regression) SDMQ9 score than those “not adequately informed” and were 3.4 times more likely (95% CI, 2.1-5.7; P < .001, multiple logistic regression) to be confident to engage in future SDM. Respondents reported that they would be motivated to engage in SDM if the clinician initiated SDM, valued input from the patient, and acknowledged that patients are experts on their own bodies or if a treatment is no longer working. Conclusions and Relevance Results of this survey study suggest that a majority of patients with eczema and caregivers prefer a large role in decision-making for their care and that clinicians can initiate and facilitate SDM to improve patient satisfaction with care.
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Affiliation(s)
| | | | - Emile Latour
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Erin Foster
- Center for Health & Healing, Oregon Health & Science University, Portland
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Cowdell F. Evidence should inform more than prescribing decisions. Br J Dermatol 2022; 187:4. [PMID: 35490370 PMCID: PMC9541342 DOI: 10.1111/bjd.21603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Linked Article:Hewitt et al. Br J Dermatol 2022; 187:82–88.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences Birmingham City University Birmingham UK
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12
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Hewitt RM, Bundy C, Newi A, Chachos E, Sommer R, Kleyn CE, Augustin M, Griffiths CE, Blome C. How do dermatologists’ personal models inform a patient–centred approach to management: a qualitative study using the example of prescribing a new treatment (Apremilast). Br J Dermatol 2022; 187:82-88. [PMID: 35064926 PMCID: PMC9540747 DOI: 10.1111/bjd.21029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Background The quality of dermatology consultations is partly determined by how clinicians approach patient care. The term ‘Personal Models’ describes the explanatory frameworks of thoughts, feelings and experiences that drive behaviour. One study found that clinicians’ personal models, specifically their beliefs about autonomy and patient self‐management, influenced the degree to which clinicians engage patients in shared decision making during consultations. Further research is needed to further explore how clinicians’ personal models inform and affect the quality of patient care. Objectives To explore how clinicians’ personal models inform shared decision making and consultation style in managing people living with psoriasis in the context of a new treatment, Apremilast. Methods A framework analysis of qualitative semi‐structured telephone interviews with 13 dermatologists from the UK and Germany who participated in a novel medicine trial for psoriasis called APPRECIATE. Results Two themes were derived from the data. Theme 1, ‘personal working models of patient care’, comprised two subthemes: ‘patient‐centredness: a continuum’ and ‘stereotypes and assumptions’. Theme 2, ‘impact of personal working models on patient care’, included three subthemes: ‘shared decision making: a continuum’, ‘consultation skills’ and ‘impact of concerns about Apremilast on prescribing behaviour’. Conclusions Although many dermatologists endorsed a patient‐centred approach, not all reported working in this way. Clinicians’ personal models, their beliefs, stereotypes, personal perceptions and assumptions about patients are likely to affect their prescribing behaviour and shared decision making. Additional specialized training and education could increase patient‐centredness and whole‐person management. What is already known about this topic?‘Personal models’ is the term used to describe the thoughts, feelings and experiences that determine behaviour. Research has shown that clinicians’ personal models can influence their approach to psoriasis management, although the evidence base is limited.
What does this study add?Some, but not all, clinicians endorse a patient‐centred approach. Clinicians’ beliefs and attitudes about patients, psoriasis and evidence for psoriasis treatments all potentially influence the degree to which clinicians champion whole‐person management. Clinicians’ personal models impact how clinicians communicate with and behave towards patients during consultations and more specifically, the extent to which they demonstrate techniques to engage patients in joint decisions related to their condition and treatment.
What are the clinical implications ofthiswork?Additional specialized training and education could help clinicians to recognize how their beliefs, feelings and experiences influence their clinical practice, extend their skills in shared decision making, and facilitate whole‐person management.
Linked Comment: F. Cowdell. Br J Dermatol 2022; 187:4. Plain language summary available online
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Affiliation(s)
- Rachael M. Hewitt
- School of Healthcare Sciences, College of Biomedical & Lifesciences Cardiff University Cardiff UK
| | - Chris Bundy
- School of Healthcare Sciences, College of Biomedical & Lifesciences Cardiff University Cardiff UK
| | - Antonia‐Luise Newi
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Evangelos Chachos
- Turner Institute for Brain and Mental Health Monash University Melbourne Australia
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Christine Elise Kleyn
- University of Manchester The Dermatology Centre, Barnes Building, Salford Royal NHS Foundation Trust Manchester UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Christopher E.M. Griffiths
- University of Manchester The Dermatology Centre, Barnes Building, Salford Royal NHS Foundation Trust Manchester UK
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Kozina Y, Politi MC, Coughlin CC. Shared decision making in pediatric dermatology: context, opportunities, and practical examples. Curr Opin Pediatr 2021; 33:402-409. [PMID: 34226425 DOI: 10.1097/mop.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Shared decision making (SDM) is an important part of patient-centered care. However, it is neither widely practiced nor researched in pediatric dermatology. In this article, we provide practical examples of how to engage in SDM in pediatric dermatology, and identify future areas of research. RECENT FINDINGS Children and parents/guardians desire SDM in clinical encounters. The process is applicable to discussions of medical as well as surgical care. Additionally, SDM can help prepare children for the transition from pediatric to adult/general providers. Clinicians often want more guidance on its implementation, and there is a dearth of research on SDM or decision tools specific to pediatric dermatology. SUMMARY SDM is underused and understudied in pediatric dermatology. This article highlights how to engage in SDM and presents opportunities for research and implementation in pediatric dermatology.
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Affiliation(s)
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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14
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Shourick J, Ahmed M, Seneschal J, Passeron T, Andreux N, Qureshi A, Chow EY, Natella PA, Harris J, Tran VT, Ezzedine K. Development of a shared decision-making tool in vitiligo: an international study. Br J Dermatol 2021; 185:787-796. [PMID: 33830502 DOI: 10.1111/bjd.20137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Shared decision-making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology. OBJECTIVES To develop and validate a SDMt for use in specialized consultation for vitiligo. METHODS A prospective cross-sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision-making in the setting of a specialized consultation for vitiligo using an anchored-theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e-Delphi method. RESULTS We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision-making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English. CONCLUSIONS We developed a tool for shared decision-making in nonsegmental vitiligo, which we translated and cross-culturally validated in a US patient population with vitiligo to ensure its generalizability.
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Affiliation(s)
- J Shourick
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France
| | - M Ahmed
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - J Seneschal
- Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - T Passeron
- Université Côte d'Azur, Department of Dermatology, CHU Nice, Nice, France.,Université Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - N Andreux
- Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy Street, Providence, RI, 02903, USA
| | - E Y Chow
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, 02903, USA
| | - P A Natella
- Assistance Publique-Hôpitaux de Paris, Public Health Department/Clinical Research Unit (URC-Mondor), Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - J Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, 01605, USA
| | - V-T Tran
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Center d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - K Ezzedine
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France.,Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
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