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

Maria Rita Bongiorno, Longo, Michelangelo La Vestita, Luca Neri, Tommaso Deboli, Pellacani, Emanuele Cozzani, Sara Izzi, Valentina Dini, Stefania Borsari, Diego Orsini, Alice Casari, Laura Mazzoni, Vieri Grandi, Antonella Fabiano, Ignazio Stanganelli, Andrea Peserico, Francesco Ricci, Marco Romanelli, Stefano DastoliIgnazio Stanganelli, Concetta Potenza, Piergiacomo Calzavara Pinton, Michelangelo La Vestita, Serafinella Cannavò, Eibenschuz, Borgia Francesco, Chiara Sabbatini - Camilla Delle Vedove, Franceschini Chiara, Domenico Costanzo, Nicolò Nami, Anna Carboni, La Viola, Gianpiero Girolomoni, Francesco La Carrubba, Carmen Cantisani, Pasquale Frascione, Giuseppe F. Amoruso, Pietro Quaglino, Massimiliano Scalvenzi, Caterina Ferreli, Domenico Bonamonte, Maria Concetta Fargnoli, Cristina Zane, Bottoni, Maria Rita Bongiorno, Gianpiero Girolomoni, Nicola Pimpinelli, Giuseppe Micali, Stefano Calvieri, Ketty Peris, Pietro Rubegni, Fabio Ayala, Aurora Parodi

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5 Citazioni (Scopus)

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 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.
Lingua originaleEnglish
pagine (da-a)93-107
Numero di pagine15
RivistaJournal of the European Academy of Dermatology and Venereology
Volume33
Stato di pubblicazionePublished - 2019

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All Science Journal Classification (ASJC) codes

  • Dermatology
  • Infectious Diseases

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Bongiorno, M. R., Longo, Vestita, M. L., Neri, L., Deboli, T., Pellacani, Cozzani, E., Izzi, S., Dini, V., Borsari, S., Orsini, D., Casari, A., Mazzoni, L., Grandi, V., Fabiano, A., Stanganelli, I., Peserico, A., Ricci, F., Romanelli, M., ... Parodi, A. (2019). 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. Journal of the European Academy of Dermatology and Venereology, 33, 93-107.