Key PointsQuestion听
What do patients and caregivers value when choosing treatments for atopic dermatitis?
Findings听
In this systematic synthesis of 62 studies including 19鈥�442 participants, patients and caregivers preferred avoiding adverse effects and valued treatment approaches that relieve itching and burning, are minimally disruptive to daily activities, have limited visibility, and sparingly use topical corticosteroids. Some studies presented varied perspectives, and 18 were at high risk for industry sponsorship bias.
Meaning听
In the first systematic review to address patient values and preferences in the management of atopic dermatitis to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.
Importance听
Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.
Objective听
To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.
Evidence Review听
Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation鈥揅onfidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.
Findings听
A total of 7780 studies were identified, of which 62 proved eligible (n鈥�=鈥�19鈥�442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.
Conclusions and Relevance听
In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.