Highlights
Development of the first Patient Decision Aid (PDA) specifically designed for adults with moderate-to-severe atopic dermatitis (AD) considering systemic treatments.
Identification of divergent priorities: Patients emphasize visual simplicity, dosing frequency, and cost, while clinicians prioritize laboratory monitoring and detailed safety data.
The implementation of a staged approach helps deliver complex therapeutic information in a patient-centered manner, facilitating more effective shared decision-making (SDM).
The PDA was developed following International Patient Decision Aid Standards (IPDAS) Collaboration guidelines, ensuring methodological rigor and clinical utility.
The Evolving Landscape of Atopic Dermatitis Management
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that significantly impacts the quality of life, psychological well-being, and economic stability of affected adults. For patients with moderate-to-severe disease, topical therapies often prove insufficient, necessitating the transition to systemic interventions. In recent years, the therapeutic armamentarium for AD has expanded rapidly, moving beyond traditional immunosuppressants to include targeted biologics (e.g., dupilumab, tralokinumab) and oral Janus kinase (JAK) inhibitors (e.g., abrocitinib, upadacitinib).
While this expansion offers hope for better disease control, it also introduces significant complexity into the clinical encounter. Patients and clinicians must now navigate a multitude of factors, including varying efficacy profiles, routes of administration, laboratory monitoring requirements, and safety concerns. Shared decision-making (SDM) has emerged as the gold standard for navigating these choices, yet the lack of standardized tools has historically hindered its implementation in dermatology. Patient Decision Aids (PDAs) are evidence-based tools designed to address this gap by providing structured information and helping patients clarify their values regarding treatment options.
Study Design and Methodological Rigor
A recent qualitative study conducted at Oregon Health & Science University (OHSU) from 2020 to 2025 aimed to develop and validate a PDA specifically for adult systemic AD treatments. The research team, led by Okereke et al., followed the International Patient Decision Aid Standards (IPDAS) Collaboration guidelines to ensure the tool’s quality and effectiveness.
The development process was divided into five distinct phases: scoping and design, prototype development, alpha testing, beta testing, and finalization. The study utilized a steering group model to maintain consistency and expert oversight throughout the process. The steering groups included a diverse cohort of 10 adult patients with moderate-to-severe AD and 6 dermatology clinicians for initial development. Subsequent phases involved refined groups, including 8 patients and 5 clinicians for alpha testing, and a finalization phase following beta testing with 8 new patients and 6 clinicians.
This iterative design allowed the researchers to capture evolving feedback and refine the PDA based on real-world clinical interactions. The primary outcome measures were qualitative thematic analyses of open-ended feedback, focusing on content clarity, visual appeal, and the relevance of the information provided.
Key Findings: Divergent Perspectives in the Consult Room
The study revealed a notable divergence in priorities between patients and clinicians, a finding that is critical for any practitioner attempting to implement SDM. Patients, with a mean age of 38.7 years, consistently valued simplicity and transparency. Their feedback emphasized the need for organized visual formatting, simplified language, and a focus on ‘lifestyle’ themes. Specifically, patients wanted clear information on efficacy (how well it works), dosing frequency (how often they need it), route of administration (injection vs. pill), and out-of-pocket costs.
In contrast, dermatology clinicians prioritized technical safety and monitoring data. Clinicians expressed a preference for detailed information regarding laboratory monitoring requirements (e.g., blood counts, liver enzymes) and comprehensive adverse effect profiles. This ‘information paradox’—where clinicians want to provide more detail than patients can easily process—highlights a major barrier to effective communication.
The researchers addressed this by developing a ‘staged approach.’ Rather than overwhelming the patient with a single, data-heavy document, the finalized PDA delivers information in layers. This allows the clinician to introduce core concepts simply while having more detailed data available as the discussion progresses or as the patient requests it. The final tool successfully integrated efficacy data, dosing schedules, and relative cost assessments into a format that patients found accessible and clinicians found sufficiently robust.
The Clinical Utility of the Staged Approach
The ‘staged approach’ identified in this study is perhaps the most significant contribution to the field of dermatologic SDM. By prioritizing simplicity in the initial stages of the discussion, the PDA enables patients to remain engaged and comprehend the foundational differences between treatment classes (e.g., biologics vs. JAK inhibitors). As the patient becomes more comfortable, the clinician can then introduce the more complex safety and monitoring data that were prioritized by the medical experts.
This methodology aligns with cognitive load theory, which suggests that individuals have a limited capacity for processing new information, especially in high-stress medical environments. By thinning the information stream, the PDA ensures that the most critical decision factors—those that align with the patient’s values—are processed first.
Expert Commentary and Clinical Implications
The development of this PDA represents a pivotal step toward more patient-centered care in dermatology. For clinicians, the tool serves as a roadmap to ensure all relevant systemic options are discussed equitably. It also helps standardize the information provided across different practices, reducing the risk of bias or the omission of key safety data.
However, it is important to acknowledge the limitations of such tools. PDAs are meant to facilitate, not replace, the clinician-patient relationship. The effectiveness of this specific PDA depends on the clinician’s willingness to dedicate time to the SDM process. Furthermore, as new therapies continue to enter the market, the PDA will require frequent updates to remain evidence-based. Future research should focus on the long-term impact of PDA use on patient adherence and clinical outcomes, such as Eczema Area and Severity Index (EASI) scores and patient-reported outcomes (PROs).
Conclusion
The qualitative study by Okereke et al. underscores the necessity of balancing patient preferences for simplicity with the clinical need for detail. The resulting PDA for adult systemic AD treatments provides a validated framework for enhancing medical discourse and ensuring that treatment choices reflect both clinical evidence and patient values. As the landscape of atopic dermatitis therapy continues to grow more complex, such tools will be indispensable for the modern dermatology practice.
References
Okereke R, Baghoomian W, Dunlap RR, Chang AD, Jacobson ME, Foster E, Fang MM, Simpson EL. Development of a Patient Decision Aid for Atopic Dermatitis Systemic Treatments in Adults. JAMA Dermatol. 2026 Feb 11:e255912. doi: 10.1001/jamadermatol.2025.5912.
Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.
Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4(4):CD001431.
