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Andrade LF, Abdi P, Mashoudy KD, Kooner A, Egler A, Urbonas R, Smith A, Yosipovitch G. Effectiveness of atopic dermatitis patient education programs - a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:135. [PMID: 38662127 PMCID: PMC11045580 DOI: 10.1007/s00403-024-02871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 01/20/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens. In addition to improving patient education, past investigations of educational interventions have demonstrated profound reductions in disease severity for patients living with AD. However, prior meta-analytical work has focused mostly on comparing in-person interventions, and thus the need to determine the effectiveness of virtual methodologies in the current post-COVID era remains. In this study, we conducted a systematic review of the literature to determine the effectiveness of online programming in AD education compared to in-person interventions. A comprehensive search was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions 2019. Studies were retrieved based on articles published up to 04 April 2023. Adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement guided the reportage process for this systematic review and meta-analysis. The primary outcome of our meta-analysis was the effect of various educational modalities on atopic dermatitis severity as measured by multiple scales across the studies, the most common including SCORAD, Dermatology Life Quality Index (DLQI), Patient Oriented Eczema Measure (POEM), and Eczema Area and Severity Index (EASI). Most studies were randomized controlled trials, primarily from North America and Western Europe and focused on patient and/or caregiver education about disease management, self-care techniques, avoidance of triggers, and comprehensive understanding of the disease process. Our pooled analyses showed that targeted educational programs in understudied adult populations can be as impactful as those in pediatric groups. Moreover, virtual interventions can be employed as constructive tools for reducing barriers of access to patient education. Future research on educational interventions should utilize various methodologies to encourage individual learning preferences with a focus on adult cohorts.
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Affiliation(s)
- Luis F Andrade
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA.
| | - Parsa Abdi
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Dr, St. John's, NL, A1B 3V6, Canada
| | - Kayla D Mashoudy
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Amritpal Kooner
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, 60515, USA
| | - Ashley Egler
- Indiana University School of Medicine, 340 W. 10th Street, Fairbanks Hall 6217, Indianapolis, IN, 46202, USA
| | - Rebecca Urbonas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road BC-71, Boca Raton, FL, 33431, USA
| | - Aaron Smith
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, 22903, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
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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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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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Guerrero D, Calmette R. Therapeutic patient education: the Avène-Les-Bains experience. J Eur Acad Dermatol Venereol 2021; 34 Suppl 5:53-57. [PMID: 32870561 DOI: 10.1111/jdv.16449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
Originally developed to improve the management of serious chronic diseases such as diabetes mellitus, obesity, cardiovascular diseases, asthma and as aftercare following oncological treatments, therapeutic patient education (TPE) has been extended to other situations, including chronic dermatoses such as atopic dermatitis, eczema and psoriasis. In this article, we provide a brief overview of the development, implementation and evaluation of TPE at the Avène-Les-Bains Hydrotherapy Center, France.
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Affiliation(s)
- D Guerrero
- Station Thermale Avène, Avène les Bains, France
| | - R Calmette
- Station Thermale Avène, Avène les Bains, France
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wollenberg A, Christen‐Zäch S, Taieb A, Paul C, Thyssen J, Bruin‐Weller M, Vestergaard C, Seneschal J, Werfel T, Cork M, Kunz B, Fölster‐Holst R, Trzeciak M, Darsow U, Szalai Z, Deleuran M, Kobyletzki L, Barbarot S, Heratizadeh A, Gieler U, Hijnen D, Weidinger S, De Raeve L, Svensson Å, Simon D, Stalder J, Ring J. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol 2020; 34:2717-2744. [DOI: 10.1111/jdv.16892] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/10/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy Ludwig‐Maximilian‐University Munich Germany
| | - S. Christen‐Zäch
- Pediatric Dermatology Unit Departments of Dermatology and Pediatrics Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - A. Taieb
- University of Bordeaux Bordeaux France
| | - C. Paul
- Department of Dermatology and Allergy Toulouse University and CHU Toulouse France
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev‐Gentofte HospitalUniversity of Copenhagen Hellerup Denmark
| | - M. Bruin‐Weller
- National Expertise Center for Atopic Dermatitis Department of Dermatology and Allergology University Medical Center Utrecht The Netherlands
| | - C. Vestergaard
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - J. Seneschal
- Department of Dermatology National Reference Center for Rare Skin Diseases Bordeaux University Hospitals Bordeaux France
| | - T. Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - M.J. Cork
- Sheffield Dermatology Research IICDUniversity of Sheffield UK
| | - B. Kunz
- Dermatologikum Hamburg Hamburg Germany
| | - R. Fölster‐Holst
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Kiel Germany
| | - M. Trzeciak
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
- ZAUM – Center of Allergy & Environment Munich Germany
| | - Z. Szalai
- Department of Dermatology Heim Pál National Children’s Institute Budapest Hungary
| | - M. Deleuran
- Department of Dermatology Aarhus University Hospital Aarhus Denmark
| | - L. Kobyletzki
- School of Medical Sciences Lund University Malmö Sweden
- School of Medical Sciences Örebro University Örebro Sweden
| | - S. Barbarot
- Department of Dermatology CHU Nantes UMR 1280 PhAN INRA, F‐44000 Nantes Université Nantes France
| | - A. Heratizadeh
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - U. Gieler
- Department of Dermatology University of Gießen and Marburg GmbH Gießen Germany
| | - D.J. Hijnen
- Department of Dermatology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - S. Weidinger
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Kiel Germany
| | - L. De Raeve
- Department of Dermatology Universitair Ziekenhuis Brussel (UZB)Free University of Brussels (VUB) Brussels Belgium
| | - Å. Svensson
- Department of Dermatology Skane University Hospital Malmö Sweden
| | - D. Simon
- Department of Dermatology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - J.F. Stalder
- Department of Dermatology CHU Nantes UMR 1280 PhAN INRAE, F‐44000 Nantes Université Nantes France
| | - J. Ring
- Department of Dermatology and Allergy Biederstein Technische Universität München Munich Germany
- Christiane‐Kühne Center for Allergy Research and Education (CK‐Care) Davos Switzerland
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van Os-Medendorp H, Deprez E, Maes N, Ryan S, Jackson K, Winders T, De Raeve L, De Cuyper C, Ersser S. The role of the nurse in the care and management of patients with atopic dermatitis. BMC Nurs 2020; 19:102. [PMID: 33292229 PMCID: PMC7640616 DOI: 10.1186/s12912-020-00494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions. MAIN BODY Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools' are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life. CONCLUSIONS Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.
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Affiliation(s)
| | - Elfie Deprez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Nele Maes
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Sheila Ryan
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Karina Jackson
- St John's Institute of Dermatology, Guy's and St Thomas' Foundation NHS Trust, London, UK
| | - Tonya Winders
- Allergy & Asthma Network / Global Allergy & Airways Patient Platform (GAAPP), Vienna, VA, USA
| | - Linda De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Christa De Cuyper
- Department of Dermatology, AZ Sint Jan, Brugge-Oostende, AV, Belgium.,EADV-Nurse Association Working group Coordinator, Lugano, Switzerland
| | - Steven Ersser
- Department of Nursing Science, Bournemouth University, Poole, UK
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_71-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Silverberg NB, Silverberg JI. We're all itchy, now what? Clin Dermatol 2018; 36:583-584. [PMID: 30217270 DOI: 10.1016/j.clindermatol.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nanette B Silverberg
- Departments of Dermatology and Pediatrics, Mt Sinai Health Systems, New York, New York, USA.
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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