VALUES AND PREFERENCES OF PATIENTS AND CAREGIVERS REGARDING TREATMENT OF ATOPIC DERMATITIS: A SYSTEMATIC REVIEW

Abstract

<h3>Introduction</h3> Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of studies addressing patient and preferences have not been previously available. <h3>Methods</h3> Paired reviewers independently systematically screened MEDLINE, EMBASE, CENTRAL, PsychINFO, and CINAHL databases from inception until Feb 2022 for studies of patients with AD or their caregivers eliciting values and preferences about treatment, rated risk of bias, and extracted data. We used thematic and inductive content analysis to qualitatively synthesize the findings. GRADE-CERQual informed rating of quality of evidence. <h3>Results</h3> We identified 7780 studies of which 62 (n=19442; median age across studies 15 years [range 3-44]) proved eligible. High certainty evidence showed that patients and caregivers prefer to start with non-medical treatments and to step-up therapy with increasing AD severity. Moderate certainty evidence showed that side-effects from treatment are a significant concern. Low certainty evidence showed that patients and caregivers prefer odourless treatments that are not visible and have a low impact on daily life. Patients value treatments capable of relieving itching and burning skin and prefer to apply topical corticosteroids sparingly. Patients value a strong patient-provider relationship. <h3>Conclusion</h3> We systematically reviewed patient and caregiver values and preferences and identified 7 themes in relation to the management of AD: there is a preference to start with non-medical treatments, avoid negative side effects, relieve itching and burning, use steroids sparingly, use treatments with limited visibility or odour, use treatments with limited impact on daily activities, and a desire for a stronger patient-provider relationship.