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


The purpose of this quality improvement project was to advance patient education by using a visual aid. The results of the preand post-implementation questionnaires suggest that the visual aid is best suited to informing patients. The visual aid itself had minimal impact on therapeutic decision-making.

For future iterations of a PDSA cycle, we simplified the visual aid (Table 2). Terminology was changed to improve clarity; the list of adverse reactions was reduced to common adverse reactions (frequency greater than 10%) and efficacy reported as two figures (primary outcome and maintenance outcome). In future studies, it would be prudent to consider patient education in the dynamic of the patient-physician relationship. Some studies have noted that patients feel their role is to simply accept decisions made by physicians.[6,7] Shared decision-making has been shown to be inhibited by patient feelings, as they may be uncomfortable to raise concerns.[4,6,7] Additionally, as patients may feel ill-equipped to be involved in care decisions, physician expertise is perceived as most important.[7] As opposed to highly detailed product monographs, a visual aid may allow patients to glean details with a glance. Therefore, incorporating patient education through visual aids has the potential to promote increased dialogue with their care provider, thereby encouraging adherence and satisfaction with their care plan.

A major limitation of this investigation was the small sample sizes, as it is difficult to estimate the true impact on larger populations. In particular, the poor reuptake by physicians post-implementation greatly limits our ability to judge how the visual aid would be used on a longer timescale. While physicians may initially be open to using the tool, an important consideration would be to know whether the visual aid added benefit to physicians' clinic encounters sufficiently in order to continue use on a routine basis. In future trials, rather than providing anonymous surveys, we plan to conduct focus groups to allow for improved follow-up as well as open discussion about the tool's utility. Overall, the visual aid was appreciated by physicians as an educational aid tool that helped to facilitate conversations, therefore, there is merit in further developing and studying its benefits in the clinic setting. Similarly, patients noted that the visual aid was helpful for better understanding the selected treatment. General feedback from physicians were that the visual aid appeared content dense due to the high amount of information provided. For future iterations of a PDSA cycle, we plan on simplifying the visual aid for patients, while maintaining the key components of indication, adverse events, efficacy, and contraindications.