Psoriasis Education Tool for Patient-physician Decision-making About Biologics

A Pilot Study

Marissa Nahirney, BHSc; Matthew Hum, MD, CCFP; Pamela Mathura, MBA; Marlene Dytoc, MD, PhD, FRCPC


Skin Therapy Letter. 2021;26(6) 

In This Article


Eight dermatologists and residents consented to participate. Of those physicians, 3 completed the post-visual aid questionnaire. Eight patients consented and completed their questionnaire during implementation. All questionnaires were completed anonymously. The participating physicians prescribed biologics to their patients at baseline, initiating approximately 2–3 patients with this treatment modality per month.

At baseline, the biologics, in order of frequency of prescribing, were: 1) secukinumab, 2) guselkumab, and 3) ustekinumab. The main factors affecting choice of biologic were co-morbidities (n=8, 100%), efficacy (n=7, 87.5%), and contraindications (n=7, 87.5%) (Figure 1). Fifty percent of physicians were familiar with the relative costs of each biologic (n=4), and 75% felt they were not adequately informed about the cost of biologics (n=6).

Figure 1.

Physician responses to factors affecting dermatologists' choice of biologic

After 3 months of use, the 'study' portion of the PDSA cycle was initiated with the administration of the post-aid questionnaire to the physicians. Post-implementation, the most popular biologics were 1) guselkumab, 2) risankizumab, and 3) ixekizumab. The physician respondents reported no significant impact of the visual aid on their choice of biologics, although (n=2, 66.5%) found the visual aids slightly useful. One physician commented that the visual aids "helped with listing the adverse effects and to show efficacy, not so much to compare biologics." Patients were asked to complete their questionnaire at the end of physician visual aid use. Generally, patients felt there was no significant impact (n=5, 62.5%) on their choice of biologic. There was a mixed response regarding the frequency that physicians used visual aids during clinic appointments in general (Figure 2). Some participants noted that the decision was still largely made by the physician, regardless of the use of the visual aid for patient education. However, there was a greater proportion of patients who indicated that the visual aids were either somewhat (n=4, 50%) or very (n=3, 37.5%) useful in explaining treatment options to them (Figure 2).

Figure 2.

Patient responses to visual aid education use and physician interactions