358 Qualitative study of medical decision making among patients with hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by recurrent, painful tunnels and abscesses predominantly in intertriginous sites. Despite the Food and Drug Administration’s approval of adalimumab for HS, prescription rates remain low. Low biologic prescription rates may result from patient preferences, provider comfort, inadequacy of real-world outcomes, or health systems factors. Poor disease control may increase need for analgesics and alternative pain-relief seeking strategies. This qualitative study aims to elucidate HS patient attitudes and knowledge about opioid and biologic therapies, preferences for provider communication, and factors influencing treatment decisions. Interviews were conducted with English-speaking patients ≥18 years of age with average Numeric Rating Scale (NRS) pain score in the past 7 days of ≥1. Data collection continued until thematic saturation was reached at 21 interviews. Mean age was 38.5 years (IQR 27.9-43.4); 76% of participants were female and 71% were African American. Almost all (96%) participants had Hurley Stage II or III disease. Mean NRS score for pain over the preceding week was 6 (IQR 3-7) and 62% of patients had Dermatology Life Quality Index scores ≥11. Factors that influenced patients’ medical decision making include perceived therapeutic risks, social influences, and access barriers. Personal factors such as disease severity, effectiveness of current regimen, and attitudes towards healthcare also influenced the decision to pursue therapies. Elucidating patient medical decision-making may uncover opportunities for improved patient-provider communication, adherence to treatment plans, and, potentially, outcomes in HS.