Decision Aid for Pediatric Atopic Dermatitis

IF 6.6 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-04-01 DOI:10.1016/j.jaip.2025.01.030

Anna B. Fishbein MD, MS , Karen Kaiser PhD , Sarah B. Welch MPH , Catherina Lu BA , Jack Osborn BS , Jessica Thomas MA , Michelle Taddeo MPH , Hosanna An BA , Andie Kwon BSN , George Luong BS , Kenneth L. Zhang BS , Stephanie M. Rangel PhD , Amy S. Paller MD, MS , James W. Griffith PhD

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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.

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儿童特应性皮炎的决策辅助。

背景：特应性皮炎是一种常见的慢性皮肤病，需要频繁的医生就诊和复杂的护理计划。尽管有越来越多的治疗选择，但没有现有的决策辅助工具来指导患者、家属和临床医生选择治疗方案。目的：我们的目标是开发一种基于证据的决策辅助工具，该辅助工具将被广泛接受，用于儿科特应性皮炎的共同决策。方法：根据严格的国际患者决策辅助标准（IPDAS），采取以下步骤：1)文献回顾；2)患者和护理人员焦点小组；3)专家访谈；4)原型制作、修改、临床中试；5)临床测试。结果：六个焦点小组提供了关于治疗经历和偏好的患者/家长偏好的见解（n=32）。9位专家访谈揭示了共同决策的实施策略，引出了沟通、患者教育、对治疗依从性的挑战和支持、有用的材料/资源以及其他成功策略等主题。利用文献综述、患者/家长焦点小组和专家访谈的内容，系统地创建了一份决策援助草案。与患者/家长的认知访谈（n=10）导致了工具的改进。临床测试表明该工具是有帮助的，满分10分，平均±SD评分为7.8±1.7 （n=18）。产生了最后的决策援助。结论：特应性皮炎患儿的决策辅助系统可用于临床就诊，并有可能提高患者/家庭对决策的参与。此外，我们还包括一份关于患者/父母价值的工作表和湿疹行动计划的实施。在未来的研究中，该工具的有效性将在人群中进行测试。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.