The current extent of and need for shared decision making in atopic dermatitis and psoriasis in the Netherlands: an online survey study amongst patients and physicians

Abstract

Background: In shared decision making (SDM), patients and physicians work together to choose the best treatment option for an individual patient. Atopic dermatitis (AD) and psoriasis are particularly suitable for SDM, considering that the best treatment option depends on a patient's preferences and values (preference-sensitive decisions). Currently, it is unknown to what extent SDM is applied in treatment decisions for these diseases in the Netherlands.

Objectives: Primary, to assess the current extent of SDM in AD and psoriasis in the Netherlands amongst patients and dermatologists. Secondary, to assess the degree to which patients and physicians endorse SDM, to explore which characteristics are related to their preference to be involved in SDM and to identify which barriers and facilitators for SDM they perceive.

Methods: Two similar online surveys, one for patients with AD or psoriasis and one for (resident) dermatologists, were carried out. The surveys comprised validated questionnaires (shared decision making questionnaire (SDM-Q; range 0-100), Control Preference Scale) and study-specific statements mainly regarding barriers and facilitators for SDM.

Results: The responses of 219 patients and 147 physicians were analysed. Dermatologists experienced significantly more SDM than patients (SDM-Q 82 vs 55; P < 0.01). Most patients and dermatologists prefer to share treatment decisions. Mainly facilitators for SDM were perceived, including the positive perception of patients and dermatologists regarding SDM. The perceived barriers included lack of continuity of care by the same physician and lack of time.

Conclusion: Despite the dermatologists' optimistic perspective, patients experience a limited extent of SDM and physicians should be aware of this gap. Improvement of SDM in AD and psoriasis is needed. The positive attitude of patients and dermatologists towards the process and outcome of SDM is important facilitators, while barriers were mainly perceived on an organizational level.

Figure 1

Incomplete surveys were defined as missing ≥ 10 items. AD, Atopic dermatitis.

Figure 2

Experienced extent of SDM by patients and dermatologists measured with SDM‐Q‐9 and SDM‐Q‐DOC respectively. SDM, Shared decision making; SDM‐Q‐9, 9‐item shared decision making questionnaire for patients; SDM‐Q‐DOC, 9‐item shared decision making questionnaire for physicians.

Figure 3

Control preference scale (CPS). Dermatologists: (A) I prefer to leave all treatment decisions to my patient; (B) I prefer that my patient makes the final treatment decision after seriously considering my opinion; (C) I prefer that the patient and I share responsibility for deciding which treatment is best; (D) I prefer that I make the final treatment decision, but seriously considers my patient’s opinion; (E) I prefer to make the final treatment decision. Patients: (A) I prefer to make the final treatment decision; (B) I prefer to make the final treatment decision after seriously considering my doctor’s opinion; (C) I prefer that my doctor and I share responsibility for deciding which treatment is best; (D) I prefer that my doctor makes the final treatment decision, but seriously considers my opinion; (E) I prefer to leave all treatment decisions to my doctor; (F) I don’t know what treatment with phototherapy/systemic therapy encounters and skip this question.