Well-informed patients prefer shared decision-making in eczema

Patients with eczema who were “well-informed” about their condition were more than three times as likely as less informed patients to use shared decision-making with their clinician in the future, according to a study.

“Engaging in shared decision-making can help patients understand and choose treatments according to their values and has been shown to improve patient satisfaction and adherence with treatment,” Isabelle J. Thibau, MPH, of the National Eczema Association in Novato, California, and colleagues wrote.

They suggested that for a condition such as eczema, with multiple available treatment options, shared decision-making is a viable clinical strategy.

With that in mind, the National Eczema Association conducted an online survey in January 2021 to gain further understanding of the “experiences, preferences, and expectations” for shared decision-making in the eczema treatment setting. The researchers aimed to gather data from both the physician and patient perspective.

The nine-item shared decision-making questionnaire (SDMQ9), in which patients answered questions based on a 6-point Likert scale, was used to assess outcomes. Scores were transformed to a 0 to 100 scale, with higher scores signifying a higher level of shared decision-making involvement. Past, present and confidence in future shared decision-making habits underwent analysis.

The data set included 1,313 respondents (mean age, 39.5 years; standard deviation [SD], 22.2 years; 79.7% women; 82.7% adults). For patients, those aged 18 years and older could respond on their own, while caregivers of patients aged 17 years or younger also were included.

The cohort’s mean Recap of Atopic Eczema score was 11.7 (SD, 7.2), while the mean SDMQ9 score was 65.2 (SD, 27.4).

Regarding present use of shared decision-making, 49.6% of 966 respondents reported that they prefer to make their final decision after seriously considering their physician’s opinion. Also, 69.4% of 955 respondents suggested that they would be very or extremely confident to engage in shared decision-making in the future.

In a comparison of patients who felt “very well informed” vs. those who felt “not adequately informed” about the causes of eczema, the well-informed group scored 14.7 (95% CI, 9.2-20.2) points higher on the SDMQ9. Moreover, the well-informed group also were 3.4 (95% CI, 2.1-5.7) times more likely to report confidence in shared decision-making in the future.

Patients also reported they would be more confident in shared decision-making if the physician initiated the conversation (28.6%), valued their input (34.7%), acknowledged that patients are experts on their own bodies (34.4%) or acknowledged when a treatment was no longer effective (63.1%).

“Acknowledgment from the clinician that the patient and caregiver perspective is valuable may also potentially increase [shared decision-making], which can increase satisfaction with the visit, ultimately leading to increased adherence and better disease control,” the researchers wrote.