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

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 buff...

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Published in:	Journal of the European Academy of Dermatology and Venereology Vol. 33; no. 1; pp. 93 - 107
Main Authors:	Neri, L., Peris, K., Longo, C., Calvieri, S., Frascione, P., Parodi, A., Eibenschuz, L., Bottoni, U., Pellacani, G., Ayala, Fabio, Quaglino, Pietro, Cannavò, Serafinella, Rubegni, Pietro, Ferreli, Caterina, Girolomoni, Gianpiero, Bongiorno, Maria Rita, Potenza, Concetta, Micali, Giuseppe, Pimpinelli, Nicola, Romanelli, Marco, Stanganelli, Ignazio, Bonamonte, Domenico, Peserico, Andrea, Fargnoli, Maria Concetta, Pinton, Piergiacomo Calzavara, Costanzo, Domenico, Cantisani, Carmen, Borsari, Stefania, Ricci, Francesco, Izzi, Sara, Chiara, Franceschini, Cozzani, Emanuele, Carboni, Anna, Amoruso, Giuseppe F., Dastoli, Stefano, Scalvenzi, Massimiliano, Deboli, Tommaso, Francesco, Borgia, Casari, Alice, Nami, Nicolò, Camilla Delle Vedove, Chiara Sabbatini ‐, Viola, La, La Carrubba, Francesco, Grandi, Vieri, Dini, Valentina, Mazzoni, Laura, Vestita, Michelangelo la, Fabiano, Antonella, Zane, Cristina, Orsini, Diego
Format:	Journal Article
Language:	English
Published:	England 01-01-2019
Subjects:	Administration, Cutaneous Aged Aged, 80 and over Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Antineoplastic Agents - therapeutic use Communication Diclofenac - therapeutic use Diterpenes - therapeutic use Drug Eruptions - etiology Female Humans Imiquimod - therapeutic use Italy Keratosis, Actinic - drug therapy Longitudinal Studies Male Medication Adherence Middle Aged Patient Reported Outcome Measures Patient Satisfaction Physician-Patient Relations Prospective Studies Quality of Life Italy
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Summary:	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 cm2 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.
Bibliography:	None. Conflict of interest Funding source ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0926-9959 1468-3083
DOI:	10.1111/jdv.15142