Speaker: Shared decision-making improves atopic dermatitis treatment
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Doctors can use shared decision-making to improve outcomes for patients with atopic dermatitis, said ACAAI executive medical director Michael S. Blaiss, MD, FACAAI, during a presentation at the organization’s Annual Scientific Meeting.
“We need to start listening to what’s important to our patients,” said Blaiss, who also is a clinical professor of pediatrics at the Medical College of Georgia in Augusta and an allergist at Good Samaritan Health Center in Norcross, Georgia.
“You need systems that are designed to serve the needs of the patient and ensure the patients are fully informed, retain control and participate in care delivery whenever possible,” he said.
Shared decision-making happens when patients and clinicians both are involved in making health care decisions informed by the best available evidence about options, benefits, harms, outcomes and costs, with the patient’s preferences in mind, Blaiss said.
“Shared decision-making leads us to what we want to accomplish, and that is patient-centered care,” he said.
The process begins with clinicians giving patients information at a level they can understand, with aids written at a fifth-grade level. Then, clinicians should ask patients about their goals and values.
“What do they want to accomplish in the treatment of their atopic dermatitis? Do they want to be completely free of the condition, or can they live with a certain amount of eczema?” Blaiss said.
Once these goals are established, the clinician describes the treatment options, along with their benefits, harms, expectations and costs. Patients would then respond with their concerns, such as difficulties in traveling regularly to the office or a fear of needles, which the clinician should consider.
“We need to understand what would work for them, and we need to understand their previous related medical experiences, because that may impact what particular treatment would work best for them,” Blaiss said.
In addition to these questions, Blaiss continued, physicians need to confirm that patients feel like they are part of the decision-making process. Through yes or no questions, clinicians should ask patients if they know the benefits and risks of each option and if they feel like they have enough support and advice to make a decision.
“And lastly, are you sure that this is the best choice for you?” Blaiss said. “Empower the patient to give us information about what they would prefer in a particular treatment.”
Patients have to buy into the treatment, Blaiss said, or they won’t adhere to it.
“We’re not there putting topical treatments on the patient. We’re not there giving them the different systemic treatments that are available for atopic dermatitis. They’re the ones who have to do the therapy,” Blaiss said, adding that adherence and outcomes both improve when shared decision-making happens.
Many physicians do not engage in shared decision-making because they feel they do not have the time. But Blaiss noted that patient decision aid tools such as “Controlling Your Eczema (Atopic Dermatitis)” offered online by ACAAI can expedite the process.
Other physicians say that shared decision-making is too difficult or that it impacts their autonomy, but Blaiss dismissed those concerns as well.
“We have these skills. It’s talking, but it’s also listening to our patient about what is important to them,” he said. “There’s no increased reimbursement for shared decision-making, but it’s the right thing to do.”
Furthermore, Blaiss rebuffed the notion that patients are not interested in shared decision-making.
“If you look at different questionnaires, patients do want to participate. It’s one of the reasons they go to the internet and many times second-guess us. They want more information about the disease they have and the different options that are out there,” he said.
Blaiss additionally warned physicians that while they may think they are engaging patients in shared decision-making, patients do not always see it that way, noting a 2020 survey of patients and their physicians about how they discussed treatment for atopic dermatitis and psoriasis.
According to the survey, doctors said they agreed with patients on which treatment to use and how to proceed with treatment 90% of the time, but the patients said they only agreed about 45% of the time on treatment and 60% of the time on how to proceed.
“It’s a complete disconnect. We think we’re doing shared decision-making, but that’s not what the patient is seeing or hearing,” Blaiss said.
It is then important for physicians to understand and effectively use shared decision-making, Blaiss said, because patient-centered care not only is here to stay, but it is also going to expand.
“We really should embrace — for better care of our patients — shared decision-making,” he said. “We have tools out there. More tools are being developed that are nonbiased, that are easy to understand and give the information that the patient needs to make an informed decision with you.”