Photo Credit: Ivan Balvan
Researchers developed a clinical practice psoriasis care algorithm designed to foster empathy, trust, and communication between clinicians and patients.
A novel algorithm for clinical practice shows promise for improving care for patients with moderate-to-severe psoriasis, according to a paper published in the Journal of Clinical Medicine.
“The present algorithm, EMPATHY (Embracing Patients’ Well-being in their Journey of Moderate-to-Severe psoriasis), aims to address the need to establish an empathetic relationship between patients and dermatologists, ultimately enhancing the patient’s perception of the care provided and their relationship with the physician, thereby improving therapy adherence,” wrote lead author Francesca Prignano, MD, PhD, and colleagues. “The adoption of this protocol is intended to enrich the patient-physician relationship while adhering to the standard timeframes for medical consultations.”
The researchers developed the EMPATHY algorithm through collaborative efforts between key opinion leaders, including dermatologists and psychologists. The algorithm is a structured framework that guides physicians from the initial patient reception to follow-up visits.
Considerations for the First Visit
The EMPATHY algorithm begins with the patient’s reception, which “is a pivotal moment that can significantly impact upon the outcome of the final visit,” the researchers wrote.
Dr. Prignano and coauthors explained that patients should be welcomed into a comfortable waiting area where the environment is both physically comforting and mentally reassuring. The presence of scientific information about psoriasis can help patients feel understood and that their condition is the focus of the clinical team.
Front office staff can also play an essential role by greeting patients warmly, providing clear information about waiting times, and addressing any concerns, especially during delays. Implementing questionnaires during the waiting period can optimize subsequent visits, allowing physicians to focus on discussing patient responses rather than waiting for them to complete forms.
According to the study authors, the initial interaction between the clinician and the patient is crucial for building a supportive and trustworthy environment. Establishing a connection through eye contact and clear, adapted language helps to create a bond of trust, as can simple gestures like inviting the patient to sit and ensuring privacy.
The researchers recommended that the clinician encourage dialogue and ensure the patient understands their condition and the planned treatment. Observing nonverbal cues, such as gestures and attire, can provide insight into the patient’s mental and emotional states. Recognizing the patient’s suffering and responding empathetically can further strengthen this bond.
“When appropriate, engaging in ‘self-disclosure’ can be a valuable tool. Some patients appreciate receiving personal advice from the dermatologist, as if the dermatologist were a family member (e.g., “If I were you, I would…”),” Dr. Prignano and colleagues explained. “However, it is crucial to exercise discretion and tailor self-disclosure to the individual patient’s preferences and cultural context.”
Skin Exams & Therapy Decision-Making
The skin examination is another pivotal moment for building trust. Even if psoriasis is localized, requesting a total-body examination signals comprehensive care.
“If the patient is embarrassed, explain that psoriasis can affect non-visible areas, including genital regions, which are important to examine as they can predict psoriatic arthritis and other issues. This examination allows for diagnosing significant but often undisclosed localizations,” Dr. Prignano and colleagues said.
Conducting physical contact with sensitivity and adherence to infection prevention protocols fosters mutual trust. Addressing patient embarrassment and asking for consent for the examination can help clinicians demonstrate respect and care. The researchers also advised documenting medications and beliefs in the medical record and addressing any misinformation with scientific facts.
Per the article, sharing the therapeutic strategy is essential to the visit. Clinicians should engage the patient in a discussion about their expectations and the potential outcomes of treatment. The authors emphasized the importance of being realistic yet reassuring, ensuring the patient understands the timeline for treatment effectiveness and possible side effects. Scheduling a follow-up appointment, ideally within a month, can help consolidate the therapeutic relationship and maintain care continuity.
Follow-Up & Subsequent Visits
In follow-up visits, the focus shifts to nurturing the ongoing patient relationship. This involves asking about changes since the last visit, discussing comorbidities, and engaging in casual conversation to build a long-term connection.
“Active listening is crucial for building rapport and understanding the patient’s perspective. While allowing patients to express themselves freely is essential, effective communication also involves guiding the conversation to ensure a focused and productive dialogue. This may involve gently redirecting the patient when necessary to stay on track and address their primary concerns,” Dr. Prignano and colleagues said.
Documenting patient feedback on therapy and observing their overall mood and satisfaction is essential for adjusting treatment plans. Clinicians should be open to revisiting and revising treatment strategies based on patient feedback.
The authors recommended concluding the visit by closing the door before the next patient arrives and never briefing colleagues while the patient or the next patient is present.
“The EMPATHY algorithm emphasizes empathy and effective communication between the physician and patient. It aims to improve the QOL of patients with psoriasis by focusing on both the disease and their psychological and social well-being,” Dr. Prignano and colleagues concluded, adding that they plan to validate the algorithm in future studies.
