Analysis of treatment goal alignment between Japanese psoriasis patients and their paired treating physicians

Abstract

BackgroundAppropriate goal‐oriented treatment strategies are important for optimal treatment outcomes and may prevent under‐treatment. As treatment goals vary by patient, a study to examine treatment goals is more meaningful when patients and their physicians are paired. There has not been any study that examines alignment between paired psoriasis patients and physicians in real‐world clinical practice using skin clearance as a treatment goal indicator.ObjectivesTo evaluate treatment goal alignment between psoriasis patients and their paired physicians, and to quantitatively identify factors associated with goal misalignment.MethodsThe study was a nationwide multicenter cross‐sectional observational study. Subjects were physician‐reported moderate‐to‐severe psoriasis patients with a history of systemic treatments, directly paired with their treating physicians. Subjects completed surveys independently. Treatment goals included seven categories, and patient–physician pairs were grouped as ‘aligned’ or ‘misaligned’ when the answers were the same or different, respectively.ResultsA total of 425 pairs (mean response rate, 94.7%) of responses were collected from 54 sites (64.8% general practitioners or clinics; 35.2% university or large hospitals). Treatment goal misalignment was found in 67.9% of the patient–physician pairs. The misalignment was mainly ‘patient predominant’ (60.9%) indicating that patients had higher goals (‘complete clearance’) than physicians. In the multivariate logistic regression analyses, patients’ treatment expectation for ‘complete clearance’ [odds ratio (OR): 1.927; 95% confidential interval (CI): 1.232–3.016] and physician rating of ‘level of understanding on treatment options’ being low (OR: 1.552, 95% CI; 1.082–2.227) were significant factors for treatment goal misalignment.ConclusionsThe majority of treatment goal misalignment was found between paired psoriasis patients and their treating physicians in Japan. The most important contributing factors to misalignment were patients’ treatment expectation for ‘complete clearance’ and physicians’ rating of their patients’ ‘level of understanding on treatment options’ being low.

Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies

“…We identified 56 studies involving 1,484 patients with either psoriasis (n = 1,147, range 1-104) or PsA (n = 337, range 1-89) ( Table 1). Study characteristics are shown in Table 1 [9][10][11][12][13][14][15]. Twenty five studies (46%) reported theoretical saturation, 35 (65%) reported multiple researcher involvement in data collection and analysis, and 45 studies (83%) provided participant quotations.…”

“…Underdiagnosis of PsA and the variability in how rheumatologists and dermatologists prescribe disease modifying treatments may lead to undertreatment of PsA (8). While tighter dis ease control has been shown to improve disease activity (9), there remains a mismatch between patient and physician perception of the severity of the condition, potentially leading to differences in the perception of need for treatment escalation (10,11). International guidelines (12,13) emphasize the need for a shared decision making approach between clinicians and patients, which requires an understanding of the goals and values of patients.…”

“…,11,19,21,22,26,27,37,39,41,42,45,46,50,51,56 "People don't realize how uncomfortable it is. If it looks bad, they sympathize, people don't realize unless it looks bad.…”

“…(19) "She's got MS, but she's less disabled than I am, and that's what's annoying. "(8) The failure of practitioners explicitly to acknowledge in consultations the feelings of stigma and lack of control often associated with psoriasis was commonly reported in both primary and Themes, illustrative quotations, and text Contributing studiesHarboring shame and judgement Marked as unhygienic and contagious2,5,7,11,[19][20][21][22]25,26,37,39,42,44,51,53,55 "My relatives do not come to our house…They say your disease is contagious and we might get infected." (11) "People take a step back, it can be horrifying, they give you a funny look, as if you have 3heads.…”

Patient preference for biologic treatments of psoriasis in Japan

“…The study adopted efficacy using PASI‐90, as it has been commonly used in contemporary clinical trials as a more stringent efficacy endpoint . This measurement is also considered “the new standard of care” in actual clinical practice for moderate to severe psoriasis treated with biologics in Japan. Moreover, the study showed that the participants always preferred a higher probability in any type of efficacy parameter, dosing convenience with fewer administration frequency, a lower probability of serious infection and lower co‐payment.…”