According to a study published in the November issue of Archives for Dermatology, one of the JAMA/Archives journals and written by scientists from the Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, treatment options and locations for individuals suffering from moderate to severe psoriasis that are compatible with the patients’ personal and professional lifestyle are more important than the probability and magnitude of treatment outcome.

In their introduction to the article, the authors explained as background information:

“As a chronic debilitating inflammatory disease of the skin and joints, psoriasis can cause considerable physical impairment. The well-being of patients is influenced not only by the disease by also by its management.

Many patients, especially those with severe psoriasis, are dissatisfied with the management of their disease and frustrated by the perceived ineffectiveness of treatments.”

In order to investigate the relative importance of the process-and-outcome aspects that are linked to available psoriasis therapy options, Marthe-Lisa Schaarschmidt and team carried out a computerized survey of 163 individuals aged 18+ who suffer with moderate to severe psoriasis, who between December 2009 and September 2010 received treatment at the University Medical Center Mannheim.

Process attributes measured included:

  • treatment location
  • duration
  • delivery technique
  • frequency
  • individual cost

Outcome attributes measured included:

  • duration and magnitude
  • probability and duration of benefit
  • severity
  • probability and reversibility of side effects

After averaging results from all study participants, the team discovered that the most important attribute was treatment location, meaning whether treatment would take place in a physician’s office, a hospital, clinic or at home, followed by probability of benefit and delivery approach.

From all aspects of outcome, participants considered the most important attribute as probability of benefit and magnitude of benefit, followed by the probability of side effects and duration of benefit.

The researchers found that participants considered adverse event and reversibility to be less important. They also discovered that older participants seemed to be less concerned about the probability of benefit in comparison with younger participants.

Among process aspects, participants considered frequency of treatment, duration, and delivery method to be important.

Expenses to be covered by the participant seem to be least relevant.

After the team adjusted for marital status and patient sex, they were unable to find considerable differences among treatment preferences; although, examinations revealed that single participants and women were more likely to care more regarding the probability of improvement compared to those living with a partner, and men.

On average, those whose monthly household income was average reported that duration of benefit was more important and viewed the severity of side effects to be less important, in comparison with participants with lower incomes. Between income groups, the importance of treatment cost covered by the participant did not differ considerably.

The researchers conclude:

“In conclusion, although patients with psoriasis attach significant importance to the probability and magnitude of benefit, it appears that process attributes, such as location and method of delivery of treatment, may be even more important. Incorporating preferences in shared decision making may facilitate treatment adherence and optimize outcome.”

Written by Grace Rattue