Shared Decision Making, Greater Satisfaction in Patients With Eczema

A greater degree of involvement in shared decision-making (SDM) can help patients with eczema understand and choose treatments that align with their values, according findings from a study published in JAMA Dermatology.

The National Eczema Association (NEA) conducted an online survey of its members in January 2021. Eligible participants were adult (aged ≥18 years) residents in the United States with a self-reported diagnosis of eczema or primary caregivers for pediatric patients.

The 9-item SDM questionnaire (SDMQ9) was used to rate the extent to which patients are involved in the process of SDM and assess their most recent eczema consultation. The Control Preferences Scale (CPS) asked how much control a patient/caregiver wanted regarding making a decision about treatment and was used to explain current preferences for engaging in SDM. Respondents were also asked how confident they felt about engaging in SDM with their primary eczema health care provider (HCP), which was used to determine confidence in engaging in future SDM.

Complete surveys from 1313 respondents were included. A majority (79.7%) of responders were women and the mean (SD) age was 46.2 (17.9) years for adult patients (n = 1086) and 7.4 (5.0) years for pediatric patients (n = 227).

Among the respondents, 708 of 957 (74.0%) were satisfied or very satisfied with their most recent consultation with an HCP, with a mean (SD) total SDMQ9 score for this visit of 65.1 (27.4) (scale, 0-100).

Regarding SDM past experience, 978 responses were included. Responders who felt “very well informed” about the causes of eczema had an average of a 14.7-point higher SDMQ9 score (95% CI, 9.2-20.2 points higher; P <.001).

For present SDM (CPS), 479 of 966 of responders (49.6%) agreed with “I prefer to make the final decision after seriously considering my doctor’s opinion.” The next most frequent response (284 of 966 [29.4%]) was “I prefer that my doctor and I share responsibility for the decision.”

A majority (655 of 944 [69.4%]) of respondents were very or extremely confident about engaging in SDM in the future (men, 77.6%; women, 68.1%). Age, education level, and income were not significant in the multivariable model. Responders who reported feeling “very well informed” about the causes of eczema were 3.4 times more likely (95% CI, 2.1-5.7 times; P <.001) to be “very or extremely” confident to engage in SDM in the future vs those who did not feel adequately informed.

Responders’ familiarity with SDM before the survey and feeling of valued opinions were associated with higher odds of feeling confident to engage in SDM in the future (odds ratio [OR], 2.4; 95% CI, 1.6-3.5; P <.001 and OR, 2.4; 95% CI, 1.2-4.5; P =.01, respectively).

Of the 213 participants who indicated their most important motivators to engage in shared decision making, the HCP valuing input from the patient (74 of 213 [34.7%]) and the HCP initiating SDM (61 of 213 [28.6%]) ranked highest.

The investigators noted that survey respondents were primarily associated with the NEA and may have more knowledge of eczema and/or a different level of engagement with their HCP. The study was also limited by its cross-sectional nature.

“HCPs have a unique opportunity to facilitate SDM in the care setting and empower patients and caregivers by embedding education into the patient interaction,” concluded the researchers. “Acknowledgment from the clinician that the patient and caregiver perspective is valuable may also potentially increase SDM, which can increase satisfaction with the visit, ultimately leading to increased adherence and better disease control.”

Disclosure: The National Eczema Association received sponsorship support from Sanofi. One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

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. Published online July 6, 2022. doi:10.1001/jamadermatol.2022.2441