Patients prefer shared decision-making regarding alopecia areata treatment

Patients with alopecia areata preferred a shared decision-making model with their dermatologists in deciding treatment, according to a study.

“Alopecia areata (AA) is an autoimmune disorder of hair loss with several therapeutic options that vary in efficacy and safety,” Sophia Reyes-Hadsall, BS, of the University of Miami Miller School of Medicine and the department of dermatology at Brigham and Women’s Hospital, and colleagues wrote in the brief report. “The complex nature of AA treatment decision-making is difficult for patients to navigate and increases reliance on their dermatologist’s guidance through shared decision-making (SDM) to make decisions that best align with their preferences.”

A cross-sectional web-based survey was sent to a sample of AA patients using the National Alopecia Areata Foundation’s list servs asking patient preferences when making treatment decisions, the patient’s perception of their most recent treatment decisions and how SDM impacted those decisions.

Of 1,074 patients who completed the survey, 46.8% (n = 503) preferred to make the final treatment decision themselves after considering their dermatologist’s opinion and 65.9% (n = 708) reported making their last treatment decision with their physician.

Patients who made their last treatment decisions completely on their own comprised 26.4% (n = 283) of the group, while 7.7% (n = 83) left the decision solely to their dermatologist.

For those patients who said they preferred SDM, physicians asking which treatment option the patient preferred (45.9% completely or strongly agreed) and physicians explaining the advantages and disadvantages of treatment options (44% completely or strongly agreed) were the components most identified as being part of the patients’ last AA treatment.

Decisional regret was reported least in those who were taking Janus kinase inhibitors — with 74.5% being satisfied with that choice — followed by biologics (60% satisfied) and the decision not to treat (55.9% satisfied).

Approximately half of patients (n = 559; 52%) felt they made the right decision. Also, 50.8% (n = 546) said they would make the same choice again.

“Patients preferred to make AA treatment decisions using SDM, which was associated with less decisional regret,” the authors wrote. “Regardless of treatment choice, implementing components of SDM may help improve the quality of treatment decisions patients make by allowing them to choose treatment options that align with their values and preferences.”