668 Qualitative assessment of patient values in decision making for alopecia areata: Preliminary results

Abstract

Alopecia areata (AA) is a common disease of hair loss with no FDA-approved therapies. While many treatments are available to patients, each have their own benefits and risks. Clarifying patient values is an important step to help patients choose the treatment that best fits their unique needs. A qualitative study using semi-structured interviews was conducted with 10 patients recruited from Brigham and Women’s Hospital dermatology clinic. Interviews were split and independently coded among two pairs of researchers. Codes were determined by consensus. Coding reliability and frequency were determined using NVIVO software. Interrater reliability ratings were κ =.77 (% agreement: 99%) and κ=.69 (% agreement: 98%) for the two coding teams, indicating good-excellent agreement. Key themes emerged: 100% of patients considered treatment efficacy, safety profile, and convenience of use when choosing an AA treatment. 90% of patients reported barriers to receiving appropriate treatment for various reasons, such as lack of local experts in hair loss, other time commitments, and health insurance coverage. The majority of patients considered physician recommendations (80%) and information found on the internet (70%) when choosing a treatment. 60% of patients sought dermatologists with qualifications such as affiliations with teaching hospitals and specialization in hair loss. Patients preferred physicians that reviewed treatment options comprehensively with good bedside manner (50%). Understanding patient values and barriers to treatment is important in the shared-decision making process. This study demonstrates that patients highly value information on treatment risks and benefits, which they obtain from multiple sources including physicians and online-based materials. These findings are important to discuss to help patients make higher quality decisions that align with their treatment preferences.