Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis

TAKE-HOME MESSAGE

• This systematic review investigated the parameters of treatment that are important to caregivers and patients with atopic dermatitis. The key themes identified included concerns about adverse effects, relief from itching, a preference for nonprescription therapy, and a preference for a strong doctor–patient relationship.
• This study identifies six key themes that patients and their caregivers value regarding the treatment of atopic dermatitis.

–  Joshua R. Ortego, MD

Written by

 

 

Sarah L. Chamlin MD

Patient and caregiver preferences guide our daily practice but are rarely incorporated into clinical practice guidelines.  This systematic review evaluated patient and caregiver preferences for atopic dermatitis (AD) treatment and identified 62 eligible studies for inclusion.  Six themes were identified and include preference for treatments that have minimal effect on quality of life, preference for relief of itching and burning, fear and concern about adverse events, improved adherence with a strong patient-clinician relationship, preference for minimal topical corticosteroids and preference to start with nonprescription, natural treatments.  The authors suggest that these themes can inform future guidelines and studies. 

Sadly, patient and caregiver preferences for AD therapy are poorly matched with the reality of effectively AD therapy.  Corticosteroid phobia remains rampant, and the ongoing search for a natural remedy has persisted for decades.  Thankfully, a strong patient-clinician relationship emerged as an important theme.  Shared decision that includes education and empathetic counseling about risks and benefits of treatments likely improves outcomes for our suffering AD patients and may even increase our own job satisfaction. 

Abstract 

IMPORTANCE

Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.

OBJECTIVE

To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.

EVIDENCE REVIEW

Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.

FINDINGS

A total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.

CONCLUSIONS AND RELEVANCE

In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.

JAMA Dermatology

Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema): A Systematic Review

JAMA Dermatol 2023 Jan 25;[EPub Ahead of Print], KA Maleki-Yazdi, AF Heen, IX Zhao, GH Guyatt, EA Suzumura, N Makhdami, L Chen, T Winders, KE Wheeler, J Wang, J Spergel, JI Silverberg, PY Ong, M O'Brien, SA Martin, PA Lio, ML Lind, J LeBovidge, E Kim, J Huynh, M Greenhawt, WT Frazier, K Ellison, K Capozza, A De Benedetto, M Boguniewicz, WS Begolka, RN Asiniwasis, LC Schneider, DK Chu 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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