Physician–patient communication and patient‐reported outcomes in the actinic keratosis treatment adherence initiative (AK‐TRAIN): a multicenter, prospective, real‐life study of treatment satisfaction, quality of life and adherence to topical field‐directed therapy for the treatment of actinic keratosis in Italy. (8th July 2018)

• Record Type: Journal Article
• Authors: Neri, L.; Peris, K.; Longo, C.; Calvieri, S.; Frascione, P.; Parodi, A.; Eibenschuz, L.; Bottoni, U.; Pellacani, G.
• Other Names: Ayala Fabio investigator.; Quaglino Pietro investigator.; Cannavò Serafinella investigator.; Rubegni Pietro investigator.; Ferreli Caterina investigator.; Girolomoni Gianpiero investigator.; Bongiorno Maria Rita investigator.; Potenza Concetta investigator.; Micali Giuseppe investigator.; Pimpinelli Nicola investigator.; Romanelli Marco investigator.; Stanganelli Ignazio investigator.; Bonamonte Domenico investigator.; Peserico Andrea investigator.; Fargnoli Maria Concetta investigator.; Pinton Piergiacomo Calzavara investigator.; Costanzo Domenico investigator.; Cantisani Carmen investigator.; Borsari Stefania investigator.; Ricci Francesco investigator.; Izzi Sara investigator.; Chiara Franceschini investigator.; Cozzani Emanuele investigator.; Carboni Anna investigator.; Amoruso Giuseppe F. investigator.; Dastoli Stefano investigator.; Scalvenzi Massimiliano investigator.; Deboli Tommaso investigator.; Francesco Borgia investigator.; Casari Alice investigator.; Nami Nicolò investigator.; Ferreli Caterina investigator.; Camilla Delle Vedove Chiara Sabbatini ‐ investigator.; Viola La investigator.; La Carrubba Francesco investigator.; Grandi Vieri investigator.; Dini Valentina investigator.; Mazzoni Laura investigator.; Vestita Michelangelo la investigator.; Fabiano Antonella investigator.; Zane Cristina investigator.; Orsini Diego investigator.;
• Is Part Of: Journal of the European Academy of Dermatology and Venereology. Volume 33:Number 1(2019)
• Page Start: 93
• Page End: 107
• Publication Date: 2018-07-08
• Subjects: Dermatology -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.5
• DOI: 10.1111/jdv.15142
• Languages: English
• ISSNs: 0926-9959

Abstract

Abstract: Background: Patients with multiple actinic keratoses (AKs) should be treated with field‐directed therapy. Such treatments challenge patients' adherence due to out‐of‐pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician–patient communication (PPC) may buffer therapy‐related distress, thus improving quality of life, treatment satisfaction and adherence. Objectives: We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field‐directed therapies. Methods: In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25 cm 2 area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field‐directed therapy. We matched self‐reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8 days; T2: 25–30 days) Results: Most patients were elderly, married, men with poor socio‐economic status and multiple lesions of the scalp or face. The majority ( n = 961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1 month was 84%. Most patients felt very supported ( n = 819, 73%) and rated dermatologist's explanations very clear ( n = 608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow‐up, especially for those on IMB (Δpre‐post = −4.00; other: Δpre‐post = −0.25; interaction P < 0.001). Communication clarity was associated with higher treatment satisfaction scores (β = 0.4–0.6, P < 0.01) and lower risk of non‐adherence among IMB patients (risk difference: 16%, P < 0.01). Conclusion: Communication clarity was associated with patient‐reported outcomes and adherence beyond AK‐related clinical parameters. Our study questions the current episodic approach to AK management and provides the rationale to develop chronic care models fostering patients' engagement and treatment alliance.