Background/Purpose: Given the complexity of available treatment recommendations, patients with psoriatic disease would benefit from a process fostering shared decision-making using a patient-centered approach. True shared decision-making is challenging during short visits but patient decision aids (DAs) can assist this. This study aimed to understand patient and clinician needs in the process of starting/switching therapy and use design thinking to develop a patient-centered DA that addresses these needs.

Methods: Design thinking, a method adopted from engineering, first seeks to understand user needs to develop a prototype which is then iteratively revised based on user input. Semi-structured interviews of ten patients and two focus groups with rheumatologists (n=7), dermatologists (including one nurse practitioner) (n=5) and specialty pharmacists (n=2) were conducted to inform the first prototype. Follow-up focus groups with the same healthcare providers and semi-structured interviews with an additional eight patients were conducted to revise the prototype. Interview transcripts were independently coded by two research team members using NVivo12 to elicit pertinent themes. Participants were continually interviewed until saturation of themes was reached where no new themes emerged.

Results: Themes were identified from clinicians and patients (representative quotes in Table 1). Interrater reliability of the two coders surpassed the a priori kappa threshold of 0.80 to ensure consistency in coding. Clinicians felt that a DA was most useful for patients initiating or switching therapies and should include basic information about the disease, managing flares, and individual therapies. Clinicians suggested that treatment options should be identified using an algorithm that considers patient characteristics (e.g., comorbidities) and then select 2-3 therapies for patients to learn about. Patients desired a DA that would give them access to all information about therapies including lifestyle alterations from medications, efficacy rates, side effects, insurance coverage, and personal testimonials from other patients. Patients and clinicians noted readability and easy navigation as necessary. Patients desired more detailed information than anticipated by clinicians or would typically be provided in a short encounter. The final decision aid prototype can be found at psoriasisdecisionaid.com.

Conclusion: Design thinking was an effective method of creating a comprehensive decision aid; including patients, clinicians and pharmacists was of critical importance in arriving at a final decision aid that serves the needs of all stakeholders. Next steps include testing how the decision impacts treatment decisions and whether it reduces decision conflict.

Table 1. Themes identified and representative quotes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilizing-design-thinking-to-develop-a-decision-aid-for-patients-with-psoriasis-and-psoriatic-arthritis/