Decision Aid for Pediatric Atopic Dermatitis

Abstract

Background: Atopic dermatitis is a common chronic skin disease that involves frequent physician visits and often complex care plans. Despite the expanding therapeutic options, there is no existing decision aid to guide patients, families, and clinicians through treatment options.

Objective: Our objective was to develop an evidence-based decision aid that would be widely accepted for shared decision-making in pediatric atopic dermatitis.

Methods: Per rigorous International Patient Decision Aid Standards, the following steps were taken: (1) literature review; (2) focus groups with patients and caregivers; (3) expert interviews; (4) prototype creation, revision, and pilot testing in the clinic; and (5) further in-clinic testing.

Results: Six focus groups provided insight into patient/parent preferences (n = 32) regarding treatment experiences and preferences. Nine expert interviews revealed implementation strategies for shared decision-making, eliciting themes of communication, patient education, challenges to and supports for treatment adherence, useful materials/resources, and other strategies for success. Using content from literature review, patient/parent focus groups, and expert interviews, a draft decision aid was systematically created. Cognitive interviews (n = 10) with patients/parents resulted in tool refinement. In-clinic testing demonstrated that the tool was helpful; an average ± standard deviation score was 7.8 ± 1.7 (0-10 scale, n = 18). A final decision aid was produced.

Conclusions: A decision aid for children with atopic dermatitis can be used for clinical encounters and has the potential to improve patient/family engagement in decision-making. In addition, we include a worksheet on patient/parent values and an eczema action plan for implementation. Efficacy of this tool will be tested across populations in future studies.

Keywords: Atopic dermatitis: Pediatrics; Decision aid; Shared decision-making.