A Patient Decision Aid for Psoriasis Based on Current Clinical Practice Guidelines

Abstract

Setting: Patients with psoriasis from a private practice in Windsor, Ontario, Canada, and a focus group of dermatologists across Canada. Participants: Focus groups of dermatologists (n=5) and patients with psoriasis (n = 7) were convened to provide feedback on balance, clarity, practicality, and items for inclusion and exclusion. Main Outcome Measures: Physician's global assessment, overall lesional assessment, and 75% reduction in Psoriasis Area and Severity Index. Results: Efficacy measures selected to reflect good control in the PDA were physician's global assessment (clear or almost clear) or overall lesional assessment (none or very mild) for topical agents and 75% reduction in Psoriasis Area and Severity Index for phototherapy and systemic agents. Where available, outcomes for serious adverse effects were displayed figuratively with efficacy measures. Deliberative questions for self-completion and a values clarification exercise were also incorporated. Conclusion: This psoriasis PDA was developed according to international standards based on content derived from current clinical practice guidelines.

Patients With Psoriasis and Personalized Trade-offs in Treatment Decisions—Lessons Learned From Focus Groups

“…PDA design typially focuses on conveying information about evidence-based treatment options, and the value-sensitive nature of the decisions. 1,2 To help patients better align treatment choices with their personal values, the specifics of patient treatment preferences must be more elaborately embedded into the design of PDAs. 3,4 We undertook detailed assessment of psoriasis patients’ treatment decision-making experiences to discover key patient preferences that can be incorporated into subsequent psoriasis PDA design.…”

Shared decision making and patient decision aids in dermatology

“…An example of a decision aid in psoriasis is available online. 8,9 Beyond provision of information on disease and treatment, pDAs can be designed to establish the need for a decision, encourage deliberation of choices, clarify patient values and elicit preferences. While pDAs were initially developed as simple decision boards diagramming risks and benefits for use during a medical encounter, they are now available in multiple other formats including interactive videodiscs, online formats, audiotapes, audio guided workbooks, and pamphlets for use before and after encounters to encourage self-reflection and deliberation.…”

“…This provides dermatologists an opportunity to work with patients in designing pDAs that inform about multiple treatment choices and to communicate uncertainty effectively about the available evidence, while also eliciting patient values and preferences. An example of a decision aid in psoriasis is available online …”

Decision Aids Help Your Shared Decision Making

“…5 It is a tremendous development to see the patient being supported with the provision of patients' decision support using the evidence-based patient decision aid (PtDA) described in this issue of the Archives. 5 Preparing a PtDA is a serious undertaking because it offers much more than the patient information leaflets that abound in physicians' offices and on patient advocacy websites.…”

“…5 It is a tremendous development to see the patient being supported with the provision of patients' decision support using the evidence-based patient decision aid (PtDA) described in this issue of the Archives. 5 Preparing a PtDA is a serious undertaking because it offers much more than the patient information leaflets that abound in physicians' offices and on patient advocacy websites. The International Patient Decision Aids Standards (IPDAS) that Tan and Wolfe 5 followed and met require using a systematic development process to provide unbiased, balanced, evidence-based information, in plain language, on the probability of benefits and harms of therapy.…”