Photo Credit: iStock.com/Jacob Wackerhausen

A new study explores gaps in how patients and physicians view psoriatic arthritis (PsA) and recommends ways for clinicians to improve PsA management.

Patients and physicians often view the symptoms of psoriatic arthritis and comorbidities differently. To better capture those differences, Philip Mease, MD, and colleagues talked to patients and physicians about their perspectives and shared the results in Open Rheumatology.

The study consisted of a focus group with four groups of 24 patients and a Delphi exercise with 13 physicians and 38 patients (who didn’t participate in focus groups). The focus groups completed four activities to rank different dimensions of psoriatic arthritis. Those in the Delphi exercise assigned 100 points across a list of different dimensions of psoriatic arthritis.

Patient Versus Clinician Perceptions

The study identified areas of congruence between physicians and patients. Specifically, six terms were in the top ten concerns for both patients and physicians:

• Arthritis;
• Fatigue;
• Disease activity;
• Pain;
• Physical functioning; and
• Spine symptoms.

Despite similarities, the researchers identified areas of convergence. Three concerns cited more often by patients included stiffness, disruption to daily activities, and sleep quality. Health concerns listed by patients also varied quite a bit, reflecting the individual nature of psoriatic arthritis symptoms.

Alongside concerns about specific symptoms and general disruptions to routine, patients also expressed anxiety around healthcare insurance coverage and future healthcare uncertainty, which physicians did not mention.

Improving Communication During Visits

To better understand a patient’s insurance and health concerns, Dr. Mease told Physician’s Weekly that clinicians should “reserve enough time to encourage the patient to freely voice their concerns and questions, and perhaps probe in some of the areas that patients identified as important, such as sleep, emotional feelings, and this whole concept of ‘uncertainty.’”

This could be done through a short questionnaire or personalized communication platform that patients engage with before or at the beginning of an appointment. The authors added a few potential questions for an engagement tool, though they note these are just examples:

• When considering any activities you have had difficulty with since our last visit (household activities, social activities, work, etc.), why were they difficult?
• What can we work on improving to help you do these or other activities?
• How are you sleeping?
• What are your top concerns about your disease?

The data also revealed that some topics of concern for patients were not commonly discussed in appointments, illustrating a need for clinicians to ask patients what matters to them individually to deliver patient-centered, understanding care.

“Patients don’t necessarily think in terms of clinical ‘domains’ in the same way as clinicians do—they may think in broader terms of pain, fatigue, itching, and the impact on their daily lives,” Dr. Mease said. “Learning about what matters to patients can make clinicians more empathic, better communicators and deepen the relationship and trust with patients.”