Insufficient Knowledge Among Psoriasis Patients Can Represent a Barrier to Participation in Decision-making

Abstract

Patient participation in treatment decisions can have positive effects on patient satisfaction, compliance and health outcomes. The objectives of this study were to examine attitudes of psoriasis patients regarding participation in treatment decisions and to evaluate the effect of a decision-aid for discussing treatment options. A "quasi experiment" was conducted in a large dermatological hospital in Italy: a questionnaire evaluating the decision-making process and treatment knowledge was self-completed by 231 consecutive psoriasis patients after routine clinical practice and by a second sample of 171 patients exposed to a decision-board. In routine clinical practice 67.9% of patients wanted to be involved in decision-making, 28.4% wanted to leave decisions entirely to the doctor and 3.7% preferred making decisions alone. 17.9% and 25.3% of the control and decision-board group had good knowledge. At multivariate analysis good knowledge increased the likelihood of preferring an active role (risk ratio (RR) = 2.21; 95% confidence interval (CI) 1.3-3.9; p = 0.006). The decision-board only marginally improved patient knowledge and doctor-patient communication. In conclusion, large proportions of psoriasis patients want to participate in decision-making, but insufficient patient knowledge can represent a barrier.

Efficacy of a Single Educative Intervention in Patients with Chronic Plaque Psoriasis

“…Poor adherence to treatment advice for psoriasis represents a major challenge to health care professionals [5]. It has been demonstrated that insufficient knowledge among patients with psoriasis can represent a barrier to therapy acceptance and adherence [6]. Indeed, effective communication between doctor and patient is crucial in the management of psoriasis [7,8].…”

Satisfaction with current psoriasis treatment: Misalignment between physician and patient perceptions

“…Patients should therefore be encouraged to disclose this information either formally via the use of standardized tools such as the DLQI or informally via a discussion. With regards to communication on treatment options, physicians may overestimate their patients' disease education [13,14,21]. Particularly, psoriasis patients have previously expressed a desire for more information from their dermatologists [16].…”

“…Such strategies emphasize active involvement by the patient and two-way communication leading to physician -patient consensus regarding the preferred treatment approach [12,14]. In relation to this, alignment between physicians and their patients is emerging as an important concept to ensure the successful implementation of a treatment plan as well as optimal outcomes [15,16].…”

Patient and citizen participation in health care decisions in Italy

“…Grilli [14] reports on a consensus conference, involving all relevant stakeholders (professional societies, patients and consumer associations, epidemiologists, health economists and administrators) aiming to develop recommendations for breast cancer follow-up. Renzi et al [15] conducted a ''quasi-experiment'' evaluating the effect of a decision-aid for discussing treatment options with psoriasis patients. Among the observational studies, Goss et al [16] have shown a low frequency of patient expressions of opinions and questions immediately before and after general practitioners (GPs) gave information, and a lack of facilitating questions by GPs, indicating a limited degree of patient involvement in the consultation.…”