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Prignano F, Campione E, Parodi A, Vegni E, Bardazzi F, Borroni RG, Burlando M, Cinotti E, Dini V, Giacchetti A, Giofrè C, Megna M, Zichichi L, Fargnoli MC. EMPATHY Life in Psoriasis: Embracing Patients' Well-Being in Their Journey of Moderate-to-Severe Psoriasis. J Clin Med 2024; 13:4469. [PMID: 39124737 PMCID: PMC11312780 DOI: 10.3390/jcm13154469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Psoriasis is a chronic inflammatory skin condition that affects millions of individuals worldwide, impacting their physical and emotional well-being. The management of psoriasis requires effective communication and a strong physician-patient relationship. Objective: We aim to develop a novel algorithm to enhance patient well-being and care in moderate-to-severe psoriasis, considering the time constraints that dermatologists have in public hospitals. Methods: This project employed a multidisciplinary approach, involving collaboration between 14 experienced dermatologists (referred to as Key Opinion Leaders: KOLs) and a psychologist. During three separate meetings (an initial virtual session, a face-to-face meeting, and a final virtual meeting), an algorithm (Embracing Patients' Well-being in their Journey of Moderate-to-Severe psoriasis: EMPATHY), describing the patient's reception through the entire first visit and follow-up visits, was developed and refined. Results: The EMPATHY algorithm provides a step-by-step approach from the moment the patient arrives at reception, through the first visit and on to subsequent visits. This algorithm fills a critical gap in the existing guidelines by specifically addressing how to foster empathy during psoriasis patient visits within time-limited consultations. The algorithm outlines patient-centered strategies at each visit. Key aspects include creating a welcoming environment, active listening, respecting privacy, tailoring communication styles, and managing patient expectations. Conclusions: The EMPATHY algorithm represents a novel and promising approach to improving patient care and well-being in moderate-to-severe psoriasis. Developed together by dermatologists and a psychologist, this algorithm offers healthcare providers practical guidance for managing both initial and follow-up patient visits. While further validation is necessary, the potential for adapting the EMPATHY algorithm to diverse healthcare settings and patient populations holds promise for improving patient outcomes across various chronic conditions.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy;
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Aurora Parodi
- Section of Dermatology, Dipartimento di Scienze della Salute, University of Genoa, Ospedale-Policlinico San Martino, IRCCS, Largo R. Benzi, 10, 16132 Genova, Italy;
| | - Elena Vegni
- Department of Health Sciences, University of Milan, 20146 Milan, Italy;
- Unit of Clinical Psychology, ASST Santi Paolo and Carlo Hospitals, 20142 Milan, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, 40126 Bologna, Italy;
| | - Riccardo G. Borroni
- Department of Biomedical Sciences, Humanitas University, 20089 Milan, Italy
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Milan, Italy
| | - Martina Burlando
- Dermatologic Clinic, DISSAL, San Martino Hospital, 16132 Genova, Italy;
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy;
| | | | - Claudia Giofrè
- Dermatology Complex Operative Unit, Papardo Hospital, 98158 Messina, Italy;
| | - Matteo Megna
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy;
| | - Leonardo Zichichi
- Unit of Dermatology, San Antonio Abate Hospital, 80057 Trapani, Italy;
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Dermatology Unit, Ospedale San Salvatore, 67100 L’Aquila, Italy
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Tsunemi Y, Otsuka A, Nonaka Y. Patient-physician perception gaps in setting treatment goals and communication including shared decision making: Results from the survey illuminating dialogues and insights in onychomycosis management (IDIOM survey). J Dermatol 2024. [PMID: 38874465 DOI: 10.1111/1346-8138.17330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
Onychomycosis, an infectious disease affecting the nails, can spread within oneself and to others, potentially leading to functional disabilities, therefore achieving a complete cure is necessary. Additionally, shared decision making (SDM) has been gaining attention in the treatment of various diseases in recent years. This study aimed to uncover the realities of patient-physician communication and perception in onychomycosis treatment, particularly in setting treatment goals and the SDM process for selecting therapeutic agents. We conducted a web-based survey of both patients and dermatologists to identify issues in the decision-making process for onychomycosis treatment. The survey revealed several communication challenges between patients and dermatologists regarding onychomycosis treatment. First, a notable percentage of dermatologists do not prioritize a complete cure for onychomycosis in their treatment goals. Second, the dermatologists' treatment explanations tended to emphasize risks, information necessary for appropriate decision-making was not adequately conveyed to patients, and SDM practice was insufficient (the mean scores of SDM-Q-9 and SDM-Q-Doc were 49.0 and 70.9, respectively). Third, dermatologists overestimated the reluctance of older patients to take oral medications. Dermatologists should recognize their patients' expectations for a complete cure for onychomycosis and choose a therapeutic agent that meets patients' needs. Furthermore, dermatologists should explain the benefits and risks of treatment options in a balanced manner, strive for improved patient-physician communication, and aim for a complete cure by administering suitable treatment.
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Affiliation(s)
- Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Atsushi Otsuka
- Department of Dermatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yusuke Nonaka
- Medical Affairs Department, Sato Pharmaceutical Co., Ltd., Tokyo, Japan
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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4
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van Huizen AM, Rietbergen NJ, van der Kraaij GE, Ubbink DT, Spuls PI. Effectiveness and patient satisfaction of a Dutch patient decision aid for psoriasis - a pilot study. J DERMATOL TREAT 2023; 34:2186157. [PMID: 36861943 DOI: 10.1080/09546634.2023.2186157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- A M van Huizen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - N J Rietbergen
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - G E van der Kraaij
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ph I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
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Yee D, Kingston P, Lee K, Huang M, Peterson H, Korouri E, Armstrong AW. Shared decision-making and satisfaction with care in patients with psoriasis: A population-based study in the United States. J Am Acad Dermatol 2023; 89:920-926. [PMID: 37011814 DOI: 10.1016/j.jaad.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a critical component of the patient-physician relationship. Although SDM has been reported to improve patient knowledge in other fields, it is still relatively unknown in dermatology. OBJECTIVE To determine the association between SDM and satisfaction with care among patients with psoriasis. METHODS Cross-sectional study using data from the 2014 to 2017 and 2019 Medical Expenditure Panel Survey. RESULTS A weighted total of 3,715,027 patients with psoriasis were identified. The average SDM score was 3.6 (of 4), and the average satisfaction with care score was 8.6 (of 10). Approximately 42% of the cohort reported having a high SDM (score, ≥3.9). Patients who had high SDM had, on average, 85% higher satisfaction with care (P < .001) after adjusting for covariates. LIMITATIONS The results of our study should be interpreted within the context of the Medical Expenditure Panel Survey database. The ability to measure SDM was limited by the 7 items from Medical Expenditure Panel Survey, which may not fully capture active participation in shared decision-making. CONCLUSION A majority of patients with psoriasis are not participating in highly SDM. It is important to construct a framework for carrying out SDM efficiently to enhance physician-patient communication and improve patient outcomes.
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Affiliation(s)
- Danielle Yee
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paige Kingston
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kathryn Lee
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Margaret Huang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hannah Peterson
- Loma Linda University School of Medicine, Loma Linda, California
| | | | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California.
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6
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Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [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: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
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Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Capozza K, Funk M, Hering M, Lang J, Merhand S, Manion R, Orevillo K, Picozza M, Proctor A, Schwennesen T, Begolka WS, Tullos K, Talent C, Tu M, Vastrup AS, Schwartz A. Patients' and Caregivers' Experiences With Atopic Dermatitis-Related Burden, Medical Care, and Treatments in 8 Countries. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:264-273.e1. [PMID: 36332836 DOI: 10.1016/j.jaip.2022.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies have documented the high patient and caregiver burden associated with atopic dermatitis (AD). Less is known about the factors-especially those related to treatment options and the delivery of medical care-that may relate to burden and unmet needs among patients and their caregivers. OBJECTIVE Our primary aim was to characterize and compare health-related quality of life, long-term control of symptoms, satisfaction with treatments, the financial burden, and the prevalence of patient-centered care among adult and pediatric patients with AD in 8 developed nations. METHODS We developed a 53-item anonymous online survey for adult patients and caregivers of children with AD (N = 3171; self-reported disease severity: 8.2% clear, 33.2% mild, 41.1% moderate, 17.6% severe). The survey included questions across 7 domains selected by a steering committee of 11 patient organizations that advocate for patients with AD in the 8 countries. We used validated instruments when available including the 5-level EuroQol five-dimensional questionnaire and the Atopic Dermatitis Control Tool. The survey was offered in 5 languages and promoted through social media and other communication channels of the patient organizations. RESULTS The health-related quality-of-life scores for adult patients with AD (driven by 2 domains: pain/discomfort and anxiety/depression) were worse than those reported for asthma and type 2 diabetes in previous studies (0.72; 95% CI, 0.65-0.78). Patients and caregivers reported substantial financial impacts even in countries with government-funded health care systems, though the greatest impact was in the United States. In all countries, adults reported better control of symptoms than children, but neither group nor any nationality reported adequate control on average (rescaled mean, 57.5; 95% CI, 56.1-58.9), and control correlated negatively with disease severity. Similarly, satisfaction with treatments, which was moderate across countries on average, was much lower for respondents with more severe disease symptoms (F(3,3165) = 5.5; P < .001). Patients who saw a specialist (a dermatologist or an allergist) instead of a general practitioner for AD care indicated better long-term control of symptoms (by 4 points on average on the 100-point scale; 95% CI, 2.6-5.4; P < .001). Finally, self-management training and shared decision making were uncommonly reported by patients in all countries except by respondents from the United States, but both were associated with better long-term control of symptoms and higher satisfaction. CONCLUSIONS The burden of AD, evaluated as health-related quality-of-life detriments, financial impacts, and uncontrolled symptoms, is significant and highest for patients with more severe atopic dermatitis who report greater challenges in achieving symptom resolution with existing treatments and approaches to care. The better outcomes associated with respondents who saw specialists suggest that patients, especially those with more severe AD, might benefit from medical care that is guided by providers with more in-depth knowledge of this complex condition. Finally, wider use of patient-centered care practices (specifically, self-management training and shared decision making) could improve outcomes and boost satisfaction with treatments for AD, though more research on this topic is warranted.
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Affiliation(s)
- Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, Calif.
| | | | | | - Jessica Lang
- Global Parents for Eczema Research, Santa Barbara, Calif
| | | | | | - Kara Orevillo
- Global Parents for Eczema Research, Santa Barbara, Calif
| | - Mario Picozza
- Associazione Nazionale Dermatite Atopica and Santa Lucia Foundation IRCCS, Rome, Italy
| | | | | | | | - Kathryn Tullos
- International Topical Steroid Awareness Network, Dallas, Tex
| | - Cheryl Talent
- Eczema Association of Australasia, Brisbane, Australia
| | - Michelle Tu
- Global Parents for Eczema Research, Santa Barbara, Calif
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Inagaki N, Tsuchiya M, Otani K, Nakayama T. Shared decision making between patients with Fabry disease and physicians in Japan: An online survey. Mol Genet Metab Rep 2022; 32:100899. [PMID: 36046392 PMCID: PMC9421488 DOI: 10.1016/j.ymgmr.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Fabry disease is a rare, progressive genetic lysosomal disorder that can cause multisystem organ dysfunction. With increasing treatment options for Fabry disease, it is imperative that patients discuss and select treatment plans in conjunction with their physicians. Although shared decision making (SDM) should be recommended for clinical decision making in disease management, evidence is limited as to how patients in Japan are involved in the choice of their Fabry disease treatment and if other gaps exist with physicians in the perception of Fabry disease management. Objective The main objective of the study was to assess the degree of agreement between patients and treating physicians in the SDM process as assessed by the SDM-Q-9 and SDM-Q-Doc questionnaires. In parallel, this study also investigated other factors that might impact the SDM process. Methods This was a cross-sectional web-based questionnaire survey of Japanese patients with Fabry disease and their treating physicians conducted from February 2021 to June 2021. Online surveys were developed for patients and physicians, consisting of seven items, including the Japanese version of the 9-item SDM Questionnaire for patients (SDM-Q-9) and physicians (SDM-Q-Doc). Physicians were divided into two cohorts: non-paired and paired with patients. Only the paired cohort physicians answered the SDM questionnaire. Results A total of 99 physicians and 30 patients answered the respective questionnaires. Among these, 13 physicians were included in a paired SDM analysis with patients. Mean (standard deviation [SD]) patient age at diagnosis of Fabry disease was 47.5 (15.8) years, and 14 (46.7%) were male. Both physicians in the paired cohort and patients considered patient-reported outcomes (both 76.7%) and the findings from laboratory testing as important (90.0% and 60.0% respectively). However, regarding symptoms that affect quality of life of patients, perception gaps were identified in that physicians in the paired cohort placed less importance on patient-reported outcome-related symptoms such as sweating abnormalities and gastrointestinal symptoms than their patients (0% [0/17] and 44.4% [8/18], 11.8% [2/17] and 38.9% [7/18], respectively). In the paired analysis, there was no significant difference in total SDM score between patients and physicians (p = 0.82). However, the largest discordance in perception between patients and physicians was identified for the explanation of the advantages and disadvantages of the treatment options (weighted Kappa coefficient = 0.14). Conclusion This survey revealed a gap in the perception of disease burden affecting patients' quality of life, and a recognition gap between physicians and patients when they discussed the advantages and disadvantages of treatment options. To improve the SDM process in Fabry disease management and treatment, practical solutions for bridging these gaps should be considered.
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Affiliation(s)
- Natsuko Inagaki
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.,Department of Clinical Genetics Center, Tokyo Medical University, Tokyo, Japan
| | | | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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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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Traidl S, Heratizadeh A. [Modern systemic therapies for atopic dermatitis : Which factors determine the choice of therapy?]. Hautarzt 2022; 73:529-537. [PMID: 35648139 DOI: 10.1007/s00105-022-05003-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
For the treatment of moderate to severe atopic dermatitis (AD), two groups of modern systemic therapies with a total of five drugs are currently approved in Germany: biologics (dupilumab, tralokinumab) and "small molecules" (abrocitinib, baricitinib, upadacitinib). The growing armamentarium of therapy options, especially with more than one drug per substance group, makes it challenging for practitioners to select the appropriate treatment for the individual patient. In this review article, the preconditions and requirements of each drug group as well as the corresponding substances are presented comparatively. On the one hand, direct therapeutic effects on the severity of the disease are considered and, on the other hand, the spectrum of potential adverse drug reactions are discussed. In particular, short- and long-term effects, the safety profile and the patient's concomitant diseases represent key factors for shared decision-making with regard to select the optimum personalized therapy option.
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Affiliation(s)
- Stephan Traidl
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Annice Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Tang MBY, Fatani M, Wiggins S, Maspero J. Physician Perception of Disease Severity and Treatment Outcomes for Children and Adolescents with Atopic Dermatitis in Emerging Economies. Dermatol Ther (Heidelb) 2022; 12:999-1013. [PMID: 35349107 PMCID: PMC9021354 DOI: 10.1007/s13555-022-00708-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Methods Results Conclusions Atopic dermatitis (AD) is a common childhood disease that occurs in up to 30% of individuals under 18 years of age. Although most forms are mild, more severe disease forms of AD including symptoms such as pruritus, xerosis, lichenification, and excoriation of the skin can cause significant problems, such as lack of sleep, lack of productivity, poor self-image, and mental health disorders among patients. It also places a burden on patients’ families, which affects home, school, and work life. In children with moderate-to-severe disease, treatment options are limited especially since doctors may not be keen to prescribe high-dose treatments to children such as potent and super-potent topical corticoid steroids and progress to systemic therapies. Relatively little is understood about how doctors determine whether the disease is mild, moderate, or severe and what they consider to be the best treatment options for patients. Therefore, we conducted a series of interviews with doctors in 11 countries with emerging healthcare to better understand their beliefs and behaviors about treating childhood AD. Our results indicated that doctors tended to underestimate the severity of a patient’s disease. Additionally, 59% of doctors felt that they were able to successfully eliminate itching and skin syndrome frequently (that is, in 70% or more of their patients) in patients with moderate disease and 33% of doctors for their patients with severe disease. These results suggest that there are many unmet needs in the treatment of children and adolescents with AD in emerging economies, whose treatment could be further optimized. Improving how doctors measure the severity of a patient’s disease should help them select the most appropriate and effective treatments for their patients.
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Affiliation(s)
- Mark B Y Tang
- The Skin Specialists and Laser Clinic, Mount Alvernia Medical Centre D, 820 Thomson Road #07-61, Singapore, 574623, Singapore.
| | - Mohammed Fatani
- Hera General Hospital, PO box 5970, Mecca, 21955, Saudi Arabia
| | - Simmi Wiggins
- Sanofi Genzyme Pte Ltd, 410 Thames Valley Park Dr, Reading, RG6 1PT, UK
| | - Jorge Maspero
- Fundacion Cidea, Paraguay, 2035, C1121ABE, Buenos Aires, Argentina
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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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13
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van Rossenberg LX, Ring D, Jacobs X, Sulkers G, van Heijl M, van Hoorn BT. Patient Perceived Involvement in Their Treatment is Influenced by Factors Other Than Independently Rated Clinician Communication Effectiveness. J Patient Exp 2021; 8:23743735211065261. [PMID: 34901411 PMCID: PMC8664301 DOI: 10.1177/23743735211065261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We analyzed (1) the correspondence of patient and clinician perceived patient involvement in decision making and ratings made by independent observer's independent ratings, as well as (2), factors associated with patient-perceived involvement, among patients seeking hand specialty care. During 63 visits, the patient, their hand specialist, and 2 independent observers each rated patient involvement in decision making using the 9-item shared decision-making questionnaire for patients and clinicians, and the 5-item observing patient involvement scale (OPTION-5). We also measured health literacy (Newest Vital Sign), patient and visit characteristics (gender, age, race, years of education, occupation, marital status, and family present). There was no correlation (ρ = 0.17; P = .17) between patient (median 42, IQR 36-44.5) and clinician (38, IQR 35-43) ratings of patient involvement in decision making. Independently rated patient involvement correlated moderately with a specialist (ρ = 0.35, P <.01), but not patient (ρ = 0.22, P = .08) ratings. The finding that patient perception of their involvement in decision making has little or no relationship to independently rated clinician communication effectiveness and effort, suggests that other aspects of the encounter-such as empathy and trust-may merit investigation as mediators of the patient agency.
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Affiliation(s)
- Luke X van Rossenberg
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - George Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - Bastiaan T van Hoorn
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
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14
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Murray S, Augustyniak M, Murase JE, Fischer-Betz R, Nelson-Piercy C, Peniuta M, Vlaev I. Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists. BMJ Open 2021; 11:e043960. [PMID: 34135086 PMCID: PMC8212186 DOI: 10.1136/bmjopen-2020-043960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The main study objective was to identify challenges and barriers experienced by dermatologists and rheumatologists when engaging women of reproductive age in shared decision-making (SDM) related to treatment and management of chronic inflammatory disease (CID) before, during and after pregnancy. DESIGN A mixed-methods study was conducted, employing (1) semistructured interviews, (2) an online survey and (3) triangulation of findings. PARTICIPANTS 524 dermatologists and rheumatologists entered the study; 495 completed it; 388 met inclusion criteria for analysis. Participants were included if actively practising in Germany (GER), the UK or the USA; had a minimum 5% caseload of female patients of reproductive age with either axial spondyloarthritis, psoriasis, psoriatic arthritis or rheumatoid arthritis; and had experience prescribing biologics. RESULTS 48 interviews and 340 surveys were analysed. Interviews underscored dermatologists and rheumatologists' suboptimal integration of SDM in clinical practice. In the survey, 90% (n=305) did not know about SDM models. A perceived lack of competency counselling patients on pregnancy and family planning was also identified during interviews. Among the survey sample, 44% (n=150) of specialists agreed they preferred leaving pregnancy-related discussions to obstetricians and/or gynaecologists and 57% (n=189) reported having suboptimal skills discussing contraceptive methods with patients. Another finding that emerged from interviews was the perception that all biologics are strictly contraindicated during pregnancy. Suboptimal knowledge was noted among 57% (n=95) of dermatologists and 48% (n=83) of rheumatologists surveyed in that regard, with a statistically significant difference by country among dermatologists (GER: 42% vs UK: 71% vs USA: 57%, p=0.015). CONCLUSIONS This study identified low levels of knowledge, skill and confidence, as well as attitudinal issues, that explain why SDM is not fully integrated in dermatology and rheumatology clinical practice. Blended-learning interventions are recommended to assist CID specialists in developing effective communication and patient engagement competencies.
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Affiliation(s)
- Suzanne Murray
- Department of Research, AXDEV Group Inc, Brossard, Quebec, Canada
| | | | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology, Palo Alto Medical Foundation, Mountain View, California, USA
| | - Rebecca Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit for Rheumatology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Morgan Peniuta
- Department of Research, AXDEV Group Inc, Brossard, Quebec, Canada
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Warwick, UK
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15
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van der Kraaij GE, van Huizen AM, Baerveldt EM, Boshuizen M, Determann D, van Ee I, Hageman M, de Kort W, Tafuni G, Smeets PMG, Spuls PI. Online decision aid for patients with psoriasis. Br J Dermatol 2020; 184:981-983. [PMID: 33369728 PMCID: PMC8248141 DOI: 10.1111/bjd.19761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- G E van der Kraaij
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - A M van Huizen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - E M Baerveldt
- Bravis hospital, Department of Dermatology, Bergen op Zoom, the Netherlands
| | - M Boshuizen
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - D Determann
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - M Hageman
- PATIENT+, Decision aid development, Utrecht, the Netherlands
| | - W de Kort
- Amphia hospital, Department of Dermatology, Breda, the Netherlands
| | - G Tafuni
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - P M G Smeets
- University Medical Center Utrecht, Department of Dermatology, Utrecht, the Netherlands
| | - Ph I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
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16
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Jowkar N, Fjeldsø N, Nørgaard LS, Sporrong SK, Jacobsen R, Kaae S. A Presentation of Central Communication Aspects in the Patient-Provider Relationship-Potential Learnings for Community Pharmacists. PHARMACY 2020; 8:pharmacy8040241. [PMID: 33352836 PMCID: PMC7768490 DOI: 10.3390/pharmacy8040241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Several studies have shown that communication between patients and HCPs is still not optimal in integrating patients’ perspectives on how best to manage their diseases and their medication. One such area where encounters between patients and professionals still needs to develop to better incorporate the patient’s perspective is pharmacy practice. The aim of this study was therefore to explore and present new typologies and communication aspects of HCP-patient relationships since a comprehensive literature search in 1997 conducted by Sondell and Söderfeldt, and relate the findings to pharmacy practice. In total, 11 articles were identified by applying the techniques of a purposeful literature search. The articles covered aspects of: shifting and adapting roles during the encounter, techniques to ensure individualizing in the encounter, avoiding inappropriate routines, coping with internet-informed patients, achieving mutual goals, dealing with uncertainty including avoiding rigid preconceptions, using social conversation, incorporating patients’ prior experiences, aligning language, adapting greetings and exploring the cultures and communication patterns of patients from other ethnic backgrounds. The variety of these communication aspects points to the immense complexity of communication as a practice discipline. This article has presented some of the literature that pharmacists can consult, in the endeavor of improving their communication practices.
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Affiliation(s)
- Nima Jowkar
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Nina Fjeldsø
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Lotte Stig Nørgaard
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Sofia Kälvemark Sporrong
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
- Department of Pharmacy, Uppsala University, 752 36 Uppsala, Sweden
| | - Ramune Jacobsen
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
| | - Susanne Kaae
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, 1165 Copenhagen, Denmark; (N.J.); (N.F.); (L.S.N.); or (S.K.S.); (R.J.)
- Correspondence: ; Tel.: +45-3533-6273
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