How Do Dermatologists’ Personal Views Affect Psoriasis Treatment Approach?

Dermatologists’ “personal models,” or beliefs and attitudes regarding psoriasis, may affect whether they adopt a patient-centered approach when treating patients with the condition, according to a study in the British Journal of Dermatology.

Researchers sought to assess how clinicians’ personal views might inform how they approach patient management with a new psoriasis treatment, apremilast.

For the study, researchers conducted semi-structured, 1-on-1 telephone interviews with the clinicians and analyzed data with a Framework Analysis.

A total of 13 dermatologists, psoriasis specialists, and dermatosis specialists in the UK and Germany from the phase 4 APPRECIATE study participated. Their mean age was 49.5 years, 7 were men, and they had a mean 21.1 years in practice and a mean of 19.0 years of psoriasis experience.

The researchers derived 2 main themes from the data: personal working models of patient care and impact of personal working models on patient care. The first theme was divided into 2 subthemes: 1) patient-centeredness: a continuum and 2) stereotypes and assumptions. The second theme included 3 subthemes: 1) shared decision-making: a continuum; 2) consultation skills; and 3) impact of concerns about apremilast on prescribing behavior.

The clinicians recognized the importance of patient-centeredness, although the extent to which they prioritized this approach varied, according to the study authors. Most clinicians were patient-focused, but some focused only on treating physical manifestations of psoriasis.

“The different approaches described by participants indicate that patient-centeredness exists on a continuum that is based on clinicians’ personal beliefs about condition management,” the investigators noted.

The clinicians’ approaches to patient care were also influenced by their stereotypes of patient characteristics. Some clinicians made assumptions about treatment preferences based on age and the patient’s level of interest and previous knowledge about psoriasis and treatment options.

Female clinicians, in particular, considered the patients’ goals for therapy and involved them in treatment decisions. Other clinicians used persuasion to encourage patients to adopt the clinicians’ goals, and some clinicians did not endorse shared decision-making.

Few clinicians showed awareness of the impact of framing treatment information in terms of gains, instead of losses. Some clinicians were concerned about the lack of robust, long-term evidence to support the use of apremilast compared with other psoriasis treatments. Some questioned the accuracy of existing guidance for prescribing apremilast and expressed concerns about potential side effects. These worries led to a trial-and-error approach for treating patients with psoriasis.

The investigators noted that the transferability of their findings is potentially limited by the small sample size, and several dermatologists were colleagues of 1 of the study authors and were actively involved in psoriasis research.

“This theory-led approach provides a basis for hypothesis testing and can inform education in consultation management,” the researchers wrote. “Improving clinicians’ awareness of how their personal models impact on psoriasis management and their relationships with patients may improve patient outcomes, such as increased adherence.”

Disclosure: This research was funded by Celgene. Some 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

Hewitt RM, Bundy C, Newi A-L, et al. How do dermatologists’ personal models inform a patient–centered approach to management: a qualitative study using the example of prescribing a new treatment (apremilast). Br J Dermatol. Published online January 22, 2022. doi:10.1111/bjd.21029