Doctors often have a limited amount of time to spend with their patients. In dermatology, for example, a shortage of practitioners can make it challenging to find the time to have meaningful and collaborative discussions about care plans.^1,2One of the ways a patient can maximize value from their dermatologist is through a shared decision-making process. Read on for insights from key healthcare leaders and to learn how UCB is helping to foster shared decision-making in dermatology.

What is shared decision-making?

Dr. Steven Daveluy, Program Director and Clinical Educator in the Department of Dermatology at Wayne State University, tells us that there are three traditional forms of decision-making in medicine: Paternalistic, which gives all control to a physician; Autonomy, which gives all control to a patient; and shared decision-making, in which, as he says, “the physician and the patient collaborate to come up with the best treatment option based on the available evidence and the patient’s preferences and goals.”

“Shared decision-making uncovers values and preferences with no set agenda about making one choice or another. It’s really, together, deciding on the best choice for a patient,” according to Dr. Mary Politi, Professor of Surgery in the Division of Public Health Sciences at Washington University School of Medicine in St. Louis.

Dr. Jason Hawkes, a medical dermatologist in the greater Sacramento area who serves on the medical board and scientific advisory committee of the National Psoriasis Foundation explained it this way: “Shared decision-making is a shift in attitude from a ‘doctor knows best’ mindset to one that is much more collaborative and inclusive of both parties in the medical decision-making process.” Hawkes shared this perspective in a UCB-sponsored episode of the National Psoriasis Foundation’s Psound Bytes podcast. The primary goal of shared decision making, he said, “is to create a safe, welcoming environment for patients to share their concerns, preferences, and priorities as it relates to their treatment. It summarizes the research and clinical evidence supporting those decisions into balanced, understandable, and digestible bits of information for our patients to consider.”

What does shared decision-making look like in practice?

Currently, there is a lack of repeatable protocols and shared decision-making tools to assist dermatology healthcare providers (HCPs) who need to counsel their patients on the best options for managing their disease while maximizing their quality of life (QoL). As a result, consults are widely inconsistent based on the individual approach of each HCP, and some patients may not have their needs adequately addressed. 

To help fill this gap, UCB and Forefront Dermatology, one of the largest dermatology practices in the US, are piloting a pre-appointment digital engagement platform that promotes shared decision-making. This collaboration with Dr. Betsy Wernli, FAAD, president of Forefront Dermatology and board-certified dermatologist, and her team aims to identify and create the tools that patients need to start thinking about their condition, symptoms, and goals ahead of their appointment, and to allow their physician to understand those insights before entering the exam room. 

It’s no secret that the evolution of technology is improving medicine. Just last year, UCB convened a multidisciplinary panel of experts to discuss how digital health options are shaping the health delivery network. Ultimately, digital tools that facilitate shared decision-making give doctors and patients what they need from each other to reach a solution together. 

According to Eric McCulley, Head of Portfolio Innovation, US Immunology, “We’re trying to build out digital tools that can help empower both the clinician and the patient on the journey, leading to better clinical outcomes, as well as data and insights that can ultimately improve patient care.” Tools such as these will hopefully improve patient autonomy, general educational biases, adherence metrics, and clinical outcomes, all while reducing decisional conflict. 

Why is shared decision-making important in psoriatic disease? 

One in three people with psoriasis may develop psoriatic arthritis (PsA).³Recent studies show that the median time from symptom presentation to disease diagnosis for psoriatic arthritis may be upward of two and a half years.⁴

With a shared decision-making tool, for example, if a psoriasis patient notes consistent joint pain on their platform questionnaire, their HCP would screen for PsA. Otherwise, that important conversation may not happen until later, delaying their PsA diagnosis and potentially leading to additional joint damage.

At the same time, people living with dermatologic conditions often have unique needs such as high occurrences of mental health conditions and other comorbidities, which demand more time from their physician.⁵

“While psycho/social issues are a top priority for many psoriasis patients, these concerns are often left out of the conversation between patients and practitioners, and therefore lead to gaps in care. With shared decision-making, there’s more opportunity to ensure all factors are considered in a treatment plan, giving the patient a better experience,” said Nicole Williams, Portfolio Innovation Partner, UCB. 

With the intricacies of managing psoriatic disease, it is crucial for patients to have conversations with their healthcare provider about any physical, emotional, or even logistical challenges they face due to their disease. This knowledge will allow the physician to make informed care decisions that address the patient’s unique clinical needs while creating a care plan with minimal disruption to their daily lives. A shared decision-making approach will help align the provider and the patient on attainable goals and promote shared accountability.

“By including the patient voice in the care decision process, we hope to improve adherence from the patient and ultimately evolve disease management to be more patient centric,” shared Donna Finale, U.S. Sustainability Lead, UCB. 

To learn more about the value of shared decision-making, watch our podcast series. Listen to the National Psoriasis Foundation’s Psound Bytes podcast episode on this important topic here.

References

1. American Academy of Dermatology. Running Dry. Available at https://www.aad.org/dw/monthly/2021/december/feature-running-dry. Accessed Feb. 22, 2023.
2. Merrit Hawkins. Physician Shortages in Medical Specialties in 2021: An Inside Look. Available at https://www.merritthawkins.com/news-and-insights/blog/healthcare-news-and-trends/physician-shortages-in-medical-specialties-in-2021-an-inside-look/. Accessed Feb. 22, 2023.
3.   National Psoriasis Foundation. About Psoriasis. https://www.psoriasis.org/about-psoriasis/. Accessed November 2022.
4. Journal of Rheumatology. Diagnostic Delay in Psoriatic Arthritis: A Population-based Study. Available at https://www.jrheum.org/content/48/9/1410. Accessed December 2022.
5. RCNi Plus. Assessing and managing mental health issues in people with chronic skin conditions. Available at https://journals.rcni.com/nursing-standard/evidence-and-practice/assessing-and-managing-mental-health-issues-in-people-with-chronic-skin-conditions-ns.2021.e11744/full. Accessed Nov. 23, 2022.

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March 2023