Assessing the Effect of Clinical Trial Evidence and Anecdote on Caregivers’ Willingness to Use Corticosteroids: A Randomized Controlled Trial

Abstract

Background: Treatment of childhood atopic dermatitis (AD) is hindered by nonadherence, but caregiver reassurance may help overcome this hurdle. Objectives: To assess caregivers’ willingness to treat childhood AD with a corticosteroid when presented with clinical trial evidence, anecdote, or both. Methods: A total of 476 caregivers were recruited through a dermatology clinic and online crowdsourcing platform. Subjects were randomized to receive clinical trial evidence, anecdote, or both, using either the term “medication” or “topical steroid.” Additional caregivers were queried about their willingness to treat with the doctor’s recommendation or without knowledge of its safety information. Responses were recorded on a 10-point Likert scale. Results: Caregivers’ willingness to treat was higher in all information assignment groups compared to those not provided with safety information: clinical trial evidence of a “medication” ( P = .003; Cohen’s d = 0.83) or “topical steroid” ( P = .030; d = 0.55), anecdote of a “medication” ( P < .0001; d = 1.37) or “topical steroid” ( P < .0001; d = 0.85), both clinical trial evidence and anecdote of a “medication” ( P < .0001; d = 1.00) or “topical steroid” ( P = .000; d = 0.89), and simply the doctor’s recommendation ( P < .0001; d = 0.92). Significance was corrected for multiple comparisons to 0.0018. There were no differences between caregivers of children with and without AD ( P = .36). Conclusions: Providing anecdotal reassurance, even in the setting of reported high willingness to treat with the doctor’s recommendation, may be an effective strategy to improve caregivers’ perceptions of starting new medications.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions

“…Even if patients do not know the side effects of TCS, they may still be afraid of using them [7]. In fact, when caregivers were not informed of the safety/efficacy of TCS, their willingness to use TCS was lower than caregivers who had knowledge of TCS [37].…”

Reducing corticosteroid phobia in pharmacy staff and parents of children with atopic dermatitis

“…Motivating parents to use treatment is thus of importance. Informing parents or caregivers about correct use of treatment and providing them with up-to-date information about effectiveness and safety, may be effective in improving perceptions towards medicines and thereby increasing adherence rates [ 20 ].…”

Assessing the effect of clinical trial evidence and anecdote on caregivers’ willingness to use corticosteroids: a randomized controlled trial: a critical appraisal

“…However, there is a paucity of well-designed trials to further characterize interventions that may reduce concerns about topical steroid safety and nonadherence to treatment. This study by Johnson et al 7 attempts to identify the elements in information delivered to patients that would improve caregiver willingness to treat with topical steroids.…”

“…Dr Feldman (Johnson et al 7 ) is a founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients' adherence to treatment. Both companies are profit making and there may be an indirect conflict of interest in research that may promote these companies.…”