Feasibility and Utility of the Psoriasis Symptom Inventory (PSI) in Clinical Care Settings: A Study from the International Psoriasis Council

Abstract

BackgroundThe Psoriasis Symptom Inventory (PSI) is a patient-reported outcome measure designed to assess psoriasis signs and symptoms.ObjectivesThe aim was to assess the usefulness of the PSI in enhancing patient care in the clinical setting.MethodsEight dermatology clinics in six countries enrolled adults representing the full spectrum of psoriasis severity who regularly received care at the clinic. Patients were administered the eight-item PSI (score range 0–32; higher scores indicate greater severity) while waiting for the physician; the physician conducted a static physician global assessment (sPGA) and estimated psoriasis-affected body surface area (BSA) at the same visit. Physicians completed a brief questionnaire after each patient visit, and were interviewed about the PSI after all patients were seen.ResultsThe clinics enrolled 278 patients; mean [standard deviation (SD)] psoriasis-affected BSA was 7.6% (11.4). Based on BSA, 47.8% had mild psoriasis, 29.1% had moderate psoriasis, and 23.0% had severe psoriasis. Based on sPGA, 18.7% were clear/almost clear, 67.3% were mild/moderate, and 14.0% were severe/very severe. The mean (SD) PSI total score was 12.2 (8.3). Physicians spent a mean (SD) 4.9 (4.8) min discussing PSI findings with their patients (range 0–20 min). Key benefits of PSI discussions included the following: new information regarding symptom location and severity for physicians; prompting of quality-of-life discussions; better understanding of patient treatment priorities; change in treatment regimens to target specific symptoms or areas; and improvement of patient–physician relationship.ConclusionsThe PSI was useful for treated and untreated patients to enhance patient–physician communication, and influenced treatment decisions.Electronic supplementary materialThe online version of this article (10.1007/s40257-019-00458-2) contains supplementary material, which is available to authorized users.

Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures

“…The Psoriasis Symptom Inventory (PSI) is a new patient-reported outcome that has been validated in clinical studies and has the potential to be used in clinical practice. [244][245][246][247][248] The PSI measures the severity of 8 psoriasis signs and symptoms: itch, redness, scaling, burning, stinging, cracking, flaking, and pain. Each item is rated on a scale of 0 to 4, yielding a total score ranging from 0 to 32.…”

Shared Decision-making in Dermatology

“…25 Two research groups noted that SDM is also useful for managing barriers to care, including depression; low self-efficacy, health literacy, and verbal aptitude; and demographic factors, such as race and employment status. 21,31 Tools for Implementing and Evaluating SDM Only 5 publications introduced SDM tools specifically for dermatologic conditions. 15,16,28,30,41 The most specific tools for SDM are PDAs.…”

Psoriasis severity: commonly used clinical thresholds may not adequately convey patient impact

“…Although clinicians may not routinely use patient‐reported outcomes such as the DLQI to measure impact of disease for their patients, the results from this review support the view that objective physician‐assessed outcome measures alone may be insufficient for evaluating disease severity. Increasing clinical use of subjective scoring systems that are more specific to the symptoms encountered by patient with psoriasis, such as the DLQI‐R or the PSI, could be useful in characterizing the impact of disease with lower BSA or lower PASI and improving access to care 19,20 . More real‐world evidence and expert consensus are needed to develop more patient‐centred guidelines for the initiation of systemic therapies in real‐world settings.…”

“…Increasing clinical use of subjective scoring systems that are more specific to the symptoms encountered by patient with psoriasis, such as the DLQI-R or the PSI, could be useful in characterizing the impact of disease with lower BSA or lower PASI and improving access to care. 19,20 More real-world evidence and expert consensus are needed to develop more patient-centred guidelines for the initiation of systemic therapies in real-world settings.…”