PDF(Pubmed)
Abstract：
UNASSIGNED: Psoriasis is a highly debilitating chronic inflammatory disease. Increased understanding of its pathophysiology has enabled development of targeted treatments such as biologics. Several medical treatments have been shown to be influenced by patients\' experiences and expectations. However, only little is known about patients\' experiences with and expectations towards biologics. Our objectives were to identify patients\' treatment experiences and treatment expectations and assess their trajectories over the course of treatment with the IL-17A inhibitor secukinumab. Moreover, we aimed to document effects of psoriasis, factors that influence symptomatology, and prior treatment experiences.
UNASSIGNED: We conducted semi-structured interviews with n = 24 patients with moderate-to-severe plaque psoriasis and employed a qualitative content analysis to derive thematic and evaluative codes. Findings were validated via peer debriefings with experienced dermatologists.
UNASSIGNED: Patients reported burdensome physical and psychological psoriasis symptoms and identified factors that can improve or worsen symptomatology, including stress and self-efficacy. Prior treatment experiences were mostly negative. Past barriers to effective treatment included time constraints or limited access. Concerning secukinumab, patients initially expected complete to partial remission of symptoms and occurrence or absence of side effects. Closer inspection of expectations and experiences revealed three trajectories. For most patients, initial expectations were met and future expectations remained unchanged. For the other patients, however, the experience did not match their initial expectation. One group then adapted their future expectations according to their experience, while the other group did not.
UNASSIGNED: To our knowledge, this is the first qualitative study to assess expectations towards treatment effectiveness and side effects, their trajectories, and interplay with experiences among psoriasis patients. Our findings highlight the value of further research on the subject in order to optimize care for psoriasis patients and to learn more about the trajectories and influence of treatment expectations in general.
Patients’ expectations towards a certain treatment can influence how well it will work and whether side effects occur or not. Such effects have been shown for a wide range of conditions, including dermatological ones. For patients suffering from psoriasis, a chronic inflammatory skin disease, modern biologics offer promising treatment options. Therefore, modern biologics are likely associated with high expectations by patients. Yet, the roles of treatment expectations and the experiences of patients undergoing biologic treatment have only received little attention to date. With this qualitative study, we aimed to understand patients’ perspectives on these treatments, the symptoms they suffer from, expectations towards treatment effectiveness and side effects as well as treatment experiences in the past and over the course of treatment with a modern biologic. To this end, we conducted and transcribed interviews with 24 patients after several months of biologic treatment. We then analyzed interview transcripts to determine underlying categories and summarized these in a common framework. We found that patients’ debilitating physical and psychological symptoms were often not well controlled in past treatments. Still, patients had positive expectations with regard to biologic treatment. For a large group of patients, their actual experiences met their expectations, leaving them with unchanged expectations for the future. Another important finding was the good understanding of factors influencing their symptomatology that patients had, like stress and self-efficacy. The reported findings may aid doctors in their clinical work, to further improve care for psoriasis patients.
UNASSIGNED: We conducted semi-structured interviews with n = 24 patients with moderate-to-severe plaque psoriasis and employed a qualitative content analysis to derive thematic and evaluative codes. Findings were validated via peer debriefings with experienced dermatologists.
UNASSIGNED: Patients reported burdensome physical and psychological psoriasis symptoms and identified factors that can improve or worsen symptomatology, including stress and self-efficacy. Prior treatment experiences were mostly negative. Past barriers to effective treatment included time constraints or limited access. Concerning secukinumab, patients initially expected complete to partial remission of symptoms and occurrence or absence of side effects. Closer inspection of expectations and experiences revealed three trajectories. For most patients, initial expectations were met and future expectations remained unchanged. For the other patients, however, the experience did not match their initial expectation. One group then adapted their future expectations according to their experience, while the other group did not.
UNASSIGNED: To our knowledge, this is the first qualitative study to assess expectations towards treatment effectiveness and side effects, their trajectories, and interplay with experiences among psoriasis patients. Our findings highlight the value of further research on the subject in order to optimize care for psoriasis patients and to learn more about the trajectories and influence of treatment expectations in general.
Patients’ expectations towards a certain treatment can influence how well it will work and whether side effects occur or not. Such effects have been shown for a wide range of conditions, including dermatological ones. For patients suffering from psoriasis, a chronic inflammatory skin disease, modern biologics offer promising treatment options. Therefore, modern biologics are likely associated with high expectations by patients. Yet, the roles of treatment expectations and the experiences of patients undergoing biologic treatment have only received little attention to date. With this qualitative study, we aimed to understand patients’ perspectives on these treatments, the symptoms they suffer from, expectations towards treatment effectiveness and side effects as well as treatment experiences in the past and over the course of treatment with a modern biologic. To this end, we conducted and transcribed interviews with 24 patients after several months of biologic treatment. We then analyzed interview transcripts to determine underlying categories and summarized these in a common framework. We found that patients’ debilitating physical and psychological symptoms were often not well controlled in past treatments. Still, patients had positive expectations with regard to biologic treatment. For a large group of patients, their actual experiences met their expectations, leaving them with unchanged expectations for the future. Another important finding was the good understanding of factors influencing their symptomatology that patients had, like stress and self-efficacy. The reported findings may aid doctors in their clinical work, to further improve care for psoriasis patients.
摘要：
■牛皮癣是一种高度衰弱的慢性炎症性疾病。对其病理生理学的日益了解使得能够开发靶向治疗如生物制剂。几种药物治疗已被证明受患者经验和期望的影响。然而,对患者对生物制剂的体验和期望知之甚少。我们的目标是确定患者的治疗经验和治疗预期，并评估他们在使用IL-17A抑制剂苏金单抗治疗过程中的轨迹。此外，我们的目的是记录牛皮癣的影响，影响症状学的因素，和以前的治疗经验。
■我们对n=24例中度至重度斑块状银屑病患者进行了半结构化访谈，并采用了定性内容分析来得出主题和评估代码。通过与经验丰富的皮肤科医生的同行汇报来验证结果。
患者报告了沉重的身体和心理牛皮癣症状，并确定了可以改善或恶化症状的因素，包括压力和自我效能感。以前的治疗经验大多是阴性的。过去有效治疗的障碍包括时间限制或获得有限。关于苏金单抗，患者最初预期症状完全缓解至部分缓解，副作用的发生或不存在。对期望和经验的仔细检查揭示了三个轨迹。对于大多数患者来说,最初的期望得到满足，未来的期望保持不变。对其他病人来说,然而,经验与他们最初的期望不符。然后一组根据他们的经验调整他们未来的期望，而另一组没有。
■据我们所知，这是第一项评估治疗效果和副作用预期的定性研究，他们的轨迹，并与银屑病患者的经验相互作用。我们的发现强调了对该主题进行进一步研究的价值，以优化牛皮癣患者的护理，并更多地了解治疗预期的轨迹和影响。
患者对某种治疗的期望会影响其效果以及是否会出现副作用。这种影响已经在广泛的条件下显示出来，包括皮肤病学的。对于患有牛皮癣的患者，慢性炎症性皮肤病,现代生物制剂提供了有希望的治疗选择。因此,现代生物制剂可能与患者的高期望有关。然而，迄今为止,接受生物治疗的患者的治疗期望和经验的作用很少受到关注.通过这项定性研究，我们旨在了解患者对这些治疗的看法，他们遭受的症状，对治疗效果和副作用的期望，以及过去和现代生物制剂治疗过程中的治疗经验。为此,我们在接受生物治疗数月后对24例患者进行了访谈并进行了转录.然后，我们分析了访谈笔录以确定基本类别，并在一个通用框架中对其进行了总结。我们发现，在过去的治疗中，患者的身体和心理症状通常没有得到很好的控制。尽管如此，患者对生物治疗有积极的期望.对于一大群病人来说，他们的实际经历符合他们的期望，让他们对未来的期望不变。另一个重要的发现是对影响患者症状的因素有很好的理解，比如压力和自我效能感。报告的发现可能有助于医生的临床工作，进一步改善银屑病患者的护理。
■我们对n=24例中度至重度斑块状银屑病患者进行了半结构化访谈，并采用了定性内容分析来得出主题和评估代码。通过与经验丰富的皮肤科医生的同行汇报来验证结果。
患者报告了沉重的身体和心理牛皮癣症状，并确定了可以改善或恶化症状的因素，包括压力和自我效能感。以前的治疗经验大多是阴性的。过去有效治疗的障碍包括时间限制或获得有限。关于苏金单抗，患者最初预期症状完全缓解至部分缓解，副作用的发生或不存在。对期望和经验的仔细检查揭示了三个轨迹。对于大多数患者来说,最初的期望得到满足，未来的期望保持不变。对其他病人来说,然而,经验与他们最初的期望不符。然后一组根据他们的经验调整他们未来的期望，而另一组没有。
■据我们所知，这是第一项评估治疗效果和副作用预期的定性研究，他们的轨迹，并与银屑病患者的经验相互作用。我们的发现强调了对该主题进行进一步研究的价值，以优化牛皮癣患者的护理，并更多地了解治疗预期的轨迹和影响。
患者对某种治疗的期望会影响其效果以及是否会出现副作用。这种影响已经在广泛的条件下显示出来，包括皮肤病学的。对于患有牛皮癣的患者，慢性炎症性皮肤病,现代生物制剂提供了有希望的治疗选择。因此,现代生物制剂可能与患者的高期望有关。然而，迄今为止,接受生物治疗的患者的治疗期望和经验的作用很少受到关注.通过这项定性研究，我们旨在了解患者对这些治疗的看法，他们遭受的症状，对治疗效果和副作用的期望，以及过去和现代生物制剂治疗过程中的治疗经验。为此,我们在接受生物治疗数月后对24例患者进行了访谈并进行了转录.然后，我们分析了访谈笔录以确定基本类别，并在一个通用框架中对其进行了总结。我们发现，在过去的治疗中，患者的身体和心理症状通常没有得到很好的控制。尽管如此，患者对生物治疗有积极的期望.对于一大群病人来说，他们的实际经历符合他们的期望，让他们对未来的期望不变。另一个重要的发现是对影响患者症状的因素有很好的理解，比如压力和自我效能感。报告的发现可能有助于医生的临床工作，进一步改善银屑病患者的护理。
