gms | German Medical Science

Background: The “Pso-Barrier”-study aims to identify barriers to guideline-based psoriasis care in five European countries. One focus is to determine the extent of patient involvement in therapy decisions, as guidelines consider shared decision-making (SDM) to be beneficial for the therapy course. Furthermore, the framework on integrated people-centred health services (IPCHS) established by the WHO 2016 defines a vision of health care that is “coordinated around people`s needs, respects their preferences, and allows for people’s participation in health affairs”. Therefore, this analysis focuses on the extent to which Polish and German patients perceive to be involved in decision-making regarding their psoriasis treatment.

Research question: Do German and Polish patients with psoriasis differ in how much they feel involved in treatment decisions?

Methods: The barriers and quality of health care are investigated in a multi-centre cross-sectional study with focus on the patients’ perspective. Various centres in five European countries (Denmark, Poland, Spain, United Kingdom, and Germany) are in involved to illustrate the range of dermatological outpatient facilities across Europe. The present data analysis refers to data from 29 centres in Germany and 9 centres in Poland. In total, 497 patients from Germany and 512 patients from Poland were questioned about sources of disease- and treatment-related knowledge as well as the inclusion of individual patient needs in therapy decision making.

Results: 27.3% of Polish and 32.0% of German patients stated that they have agreed on therapy goals with their dermatologist. However, 42.7% of the Polish and 31.4% of the German patients were convinced that the achievement of those therapy-goals was not measured by their dermatologists (German patients: 45.8% not sure and 22.8% yes, Polish patients: 44% not sure, 13.3% yes). Yet, 58.6% of the Polish and 76.2% of the German patients were quite or very sure that their needs regarding the kind of treatment were included in the treatment decision by their dermatologist. Additionally, 53% of the Polish and 71.4% of the German patients stated that their wishes regarding the avoidance of certain side effects were taken into account. Moreover, 51.6% of the Polish and 59.8% of the German patients mentioned that their preferences about treatment costs were considered important in the treatment choice. In terms of retrieving information on therapy options, 59.3% of the Polish and 37.6% of the German patients stated that they gain knowledge from the internet. 10% of the German patients and 3.8% of the Polish patients already participated in patient trainings.

Discussion: Polish patients appear less likely to feel that their needs are adressed by the treatment decision especially in terms of avoiding side effects. Differences in the health care system restricting access to certain treatment options could be reasons why wishes are not considered. Other explanations could reflect traditional roles of physicians in the countries. The higher number of Polish patients searching for information about treatment options in the internet may show their need to find alternatives that meet their therapy goals better. In both countries, however, there seems to be room for improvement when it comes to respecting the patient perspective.

Practical implications: The foundation for a different role concept of physicians could already be established in medical training. Instruments to assess patient preferences such as the Patient benefit index (PBI) could help to incorporate individual treatment aims into dermatological consultations.