Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema): A Systematic Review

Keon Andre Maleki-Yazdi, Department of Medicine, McMaster University, Hamilton, Canada.
Anja Fog Heen, Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
Irene X. Zhao, Department of Medicine, McMaster University, Hamilton, Canada.
Gordon H. Guyatt, Department of Medicine, McMaster University, Hamilton, Canada.
Erica A. Suzumura, Department of Preventive Medicine, Faculdade de Medicina Universidade de Sao Paulo, Sao Paulo, Brazil.
Nima Makhdami, Department of Medicine, McMaster University, Hamilton, Canada.
Lina Chen, Faculty of Medicine, University of Ottawa, Ontario, Canada.
Tonya Winders, Allergy & Asthma Network, Vienna, Virginia.
Kathryn E. Wheeler, Department of Pediatrics, University of Florida, Gainesville.
Julie Wang, Icahn School of Medicine at Mount Sinai, New York City, New York.
Jonathan Spergel, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics-Perelman School of Medicine at University of Pennsylvania, Philadelphia.
Jonathan I. Silverberg, Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Peck Y. Ong, Children's Hospital Los Angeles, University of Southern California, Los Angeles.
Monica O'Brien, Tufts University School of Medicine, Boston, Massachusetts.
Stephen A. Martin, University of Massachusetts Chan Medical School, Worcester.
Peter A. Lio, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Mary Laura Lind, School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe.
Jennifer LeBovidge, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Elaine Kim, Toronto, Ontario.
Joey Huynh, Orthopedic Neurological Rehabilitation, Northridge, California.
Matthew Greenhawt, University of Colorado School of Medicine, Aurora.
Winfred T. Frazier, Department of Family Medicine, UPMC St Margaret, Pittsburgh, Pennsylvania.
Kathy Ellison, Westerville, Ohio.
Korey Capozza, Global Parents for Eczema Research, California.
Anna De Benedetto, Department of Dermatology; University of Rochester Medical Center, Rochester, New York.
Mark Boguniewicz, University of Colorado School of Medicine, Aurora.
Wendy Smith Begolka, National Eczema Association, Novato, California.
Rachel Netahe Asiniwasis, Origins Dermatology Centre, University of Saskatchewan, Regina, Saskatchewan, Canada.
Lynda C. Schneider, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Derek K. Chu, Department of Medicine, McMaster University, Hamilton, Canada.

Document Type

Journal Article

Publication Date

1-25-2023

Journal

JAMA dermatology

DOI

10.1001/jamadermatol.2022.6045

Abstract

IMPORTANCE: Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available. OBJECTIVE: To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized. EVIDENCE REVIEW: Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence. FINDINGS: A total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias. CONCLUSIONS AND RELEVANCE: In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.

Department

Dermatology

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