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A panel of experts recently provided guidance for dermatologists to adopt a person-centered approach to psoriasis care.
The negative impact of psoriasis reaches beyond the physical pain and discomfort and can severely impact mental stability and overall QOL. Studies have shown a link between psoriasis and psychiatric comorbidities such as anxiety and depression. The disease has also been linked to diminished workplace productivity, reduced social interaction, and compromised family and friend relationships.
Although many medical professionals are aware of the repercussions of psoriasis on a patient’s QOL, there is limited guidance regarding the inclusion of well-being as a component of healthcare protocol. Survey results published in 2022 indicated that 40% of patients with psoriasis felt their dermatologist did not perceive their well-being as a goal in their treatment strategy. This made the patient feel as though their care was inadequate to improve their symptoms.
Rachel Sommer, PhD, and colleagues addressed the gap in clinical guidance by assembling a panel of experts and conducting an extensive literature review to establish well-being as a significant component of holistic psoriasis care. The team published their recommendations in the Journal of the European Academy of Dermatology & Venereology.
After applying a keyword search to the applicable literature, the expert panel found 45 publications about psoriasis and well-being. Online rounds and a face-to-face meeting between the experts resulted in recommendations that address the inclusion of well-being in psoriasis care and related challenges. (Table)
Well-Being Definition & Standard Measure
Experts scrutinized the correlation between successful physical treatment of the disease and the improvement of well-being.
“Considering there is a discrepancy between the objective tools commonly used to assess treatment success and patient-reported outcomes (PROs), it is essential to clarify the needs of each patient to guarantee a complete well-being beyond the mere PASI [Psoriasis Area and Severity Index] improvement through medical treatments, since a biologic or other medicine may not be sufficient to ensure a complete well-being according to the patient’s perspective,” Dr. Sommer and colleagues said.
The expert panel pointed out the usefulness of the World Health Organization-5 Well-Being Index. They noted that getting the patient’s perspective on their well-being is necessary for clinicians to understand the true impact of psoriasis.
Dr. Sommer and colleagues also discussed disease severity assessment, particularly concerning one of the most widely used QOL assessment tools in psoriasis care—the Dermatology Life Quality Index (DLQI). The drawbacks of this index include perceived biases, item inadequacy, and underestimating the overall burden of the disease. It also does not include feedback from the patient or the physician.
DLQI is not the only assessment tool that is insufficient for gauging the well-being of a patient with psoriasis. The panel recommends adding items like happiness to assessment tools would contribute to a more sufficient reading of patient well-being.
A Shift Toward People-Centered Healthcare
At the heart of the panel’s recommendations is a shift in the way clinicians view well-being. The experts said that well-being should become a standard part of assessing and treating patients with psoriasis. Movement toward this goal would include healthcare policy that puts people at the center of care. This would redefine care goals, focusing more on meaningful treatment, not just disease-directed treatment.
The panel acknowledged that a multidisciplinary strategy is vital to achieving a people-centered healthcare approach in practice. Communication and shared decision-making (SDM) will also be at the forefront of this paradigm shift. The fluid exchange of information and the inclusion of multiple perspectives will help reframe well-being as a significant treatment goal.
“In routine care, there are several means of measuring well-being in a valid way. Several studies have shown positive associations of patient centricity with satisfaction, well-being, adherence, health behavior, disease knowledge, and recovery rate,” Dr. Sommer and colleagues concluded.
Experts hope this shift will have positive results, adding, “Optimized outcomes may encourage dermatologists to apply this person-centered care in practice, including SDM and measurement of well-being.”
