How do dermatologists’ beliefs, emotions and experiences influence the care of people with psoriasis? An interview study using the example of prescribing a new treatment called apremilast

Linked Article: Hewitt et al. Br J Dermatol 2022; 187:82–88.

Psoriasis is a long-term inflammatory skin condition and patients need ongoing care and support to live well with their condition. The quality of care provided is likely to be influenced by the way a dermatologist approaches psoriasis management, and how much they want the patient to be involved with that care.

We know that sharing decision-making with patients can improve their outcomes. It seems that clinicians’ personal models can influence whether they encourage joint decisions with patients about their management during consultations, although research evidence about this is limited. By ‘personal models’ we mean clinicians’ thoughts, feelings, and experiences related to psoriasis and its management.

Introducing new psoriasis treatments provides an opportunity to help us examine how clinicians approach involving patients in the care they provide. In this study, with authors from the UK, Germany and Australia, we used the example of starting patients on a new drug called apremilast to look at this.

A total of 13 dermatologists from the UK and Germany took part in interviews. Two main themes were identified from the results: (1) personal working models of patient care and (2) the impact of personal working models on patient care.

Our findings suggest the thoughts, feelings and experiences held by dermatologists relating to psoriasis, treatment options, patient qualities and characteristics, and available evidence all influence how they manage consultations with patients. Some clinicians supported joint decision-making with patients, but not all seemed to work this way in reality. We believe extra training and education for dermatology clinicians could help to change their approach to caring for people with psoriasis.