A changed life: the life experiences of patients with psoriasis receiving biological treatment

• Published in: British journal of dermatology (1951) Vol. 183; no. 3; pp. 516 - 523
• Main Authors: Trettin, B., Feldman, S.R., Andersen, F., Danbjørg, D.B., Agerskov, H.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2020
• Subjects: Anxiety; Biological products; Fear; Humans; Life Change Events; Longitudinal Studies; Patients; Psoriasis; Psoriasis - drug therapy; Quality of Life; Withdrawal
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.18876

Summary
Background
Psoriasis has a large negative impact on quality of life and is associated with both depression and anxiety. The introduction of biologics has improved treatment outcomes, but the ways in which patients perceive these improvements are not well characterized.
Objectives
To investigate the everyday life experiences of patients with psoriasis receiving biological treatment in order to gain an understanding of their needs and to improve the quality of care.
Methods
A qualitative narrative methodology was utilized. In total 48 h of participant observations during consultations, and 15 semistructured interviews, were conducted with patients receiving biological treatment. Data were analysed according to Ricoeur's theory of interpretation.
Results
Receiving biological treatment was experienced as a turning point, with a significant impact on physical, psychological and emotional levels. However, psychological consequences, such as isolation and social withdrawal, seemed to be a part of the patient's identity; the negative perceptions of psoriasis left marks behind that affected the patient's self‐image. Perceived fear of discontinuation of the biological treatment resulted in insecurity, and patients were reluctant to initiate discussion about these concerns with healthcare professionals.
Conclusions
Providing assistance when patients enter the transition of receiving biological treatment may be important. Patients’ fear of biological treatment being discontinued is an ongoing issue that healthcare professionals could address.
What's already known about this topic?
Patients with psoriasis are marked by the disease physically, psychologically and emotionally.
The introduction of biologics has improved treatment outcomes and health‐related quality of life.
What does this study add?
This is the first qualitative study to explore the everyday life experiences of patients with psoriasis receiving biological treatment.
The personal transition from having psoriasis to having clear skin is a major physical change, but psychological issues caused by psoriasis remain.
Fear of treatment discontinuation is an ongoing emotion; patients are reluctant to initiate discussion about these concerns with healthcare professionals.
What are the clinical implications of this work?
Entering the personal transition of receiving biological treatment may require assistance from healthcare professionals.
A patient‐centred approach is significant in order to recognize the need for individualized care of the patient.
Healthcare professionals should address patients’ fear of discontinuation in order to reduce uncertainty and to ensure that patients are fully informed about their future treatment.
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