Patient Decision Aid Aims to Improve Treatment Selection in Atopic Dermatitis

A newly developed patient decision aid (PDA) could help adults with moderate to severe atopic dermatitis make more informed choices about systemic treatments, according to research published in JAMA Dermatology.¹

“Decision-making is a critical component of health care delivery, but the number of therapies available can be overwhelming to patients, preventing them from making fully informed care decisions,” the authors wrote. “Patients with atopic dermatitis often face this challenge, as the AD therapeutic landscape is rapidly expanding.”

The study found that a staged approach to presenting treatment information may effectively deliver complex medical details in a patient-centered manner.

Bridging the Gap Between Simplicity and Detail

The researchers developed the PDA following International Patient Decision Aid Standards Collaboration guidelines through a systematic 5-phase process from 2020 to 2025. The development involved multiple rounds of testing with patient and clinician steering groups.

Initially, 10 adult patients with moderate to severe atopic dermatitis (mean age, 38.7 years; 8 female) and 6 dermatology clinicians participated in prototype development. Patients identified efficacy as their top priority, followed by adverse events (AEs) and cost. Treatment frequency and administration route were also important. Clinicians, however, emphasized the need for complete AE lists, laboratory monitoring requirements, and detailed efficacy data.

This conflict between patient preference for simplicity and clinician desire for comprehensive information presented the greatest development challenge, the authors explained. Early prototypes that attempted to include all clinician-requested details overwhelmed patients, who reported "information overload."

“The final version strikes a balance between initial simplicity and detail, allowing for progressive exposure to detail, representing a novel approach to PDA structure and use,” the authors wrote.

A Staged Solution to Shared Decision-Making Barriers

The final PDA uses a novel staged approach to resolve the conflict between simplicity and detail. An introductory instruction page explains why systemic treatment may be needed and reinforces the chronic nature of atopic dermatitis. The first treatment page groups medications into 4 classes—phototherapy, immunosuppressants, biologics, and Janus kinase inhibitors—with simplified bullet points highlighting key differences.

After selecting a medication class, patients can access subsequent pages with detailed characteristics of individual medications, including specific AE probabilities, laboratory monitoring requirements, dosing schedules, and expected time to improvement.

“We observed that a staged approach allowed patients to process their treatment options more effectively and eliminated the need to read details of therapy classes that they are not interested in pursuing," the authors wrote.

Beta testing with 8 new patients and 6 clinicians revealed initial confusion with graphic design and organization. Some patients expressed that the visual layout might bias them toward certain treatments. Clinicians expressed concern that poor visual organization could lead to suboptimal decision-making.

The final version incorporates a color-coded arrow system to help visual learners interpret efficacy levels. Medications are organized by class to reduce repetition and present information more clearly. For each medication, the tool includes common AEs with probability percentages specific to atopic dermatitis.

During final review by the original steering committee, most participants strongly favored the staged approach as an effective solution to balancing simplicity with necessary detail.

Implications for Shared Decision-Making in Atopic Dermatitis

Growing evidence, including the new study, suggests that shared decision-making improves patient knowledge, satisfaction, and treatment outcomes,² the authors noted. However, PDAs remain underutilized in atopic dermatitis care.³ No PDAs have been published for adult atopic dermatitis, and a pediatric version was only recently introduced.¹

The study had several limitations, including the single-center design and relatively small sample size. Further testing in diverse populations with varying literacy levels is needed to assess broader applicability.

“This study supports that a staged approach may effectively deliver complex treatment information in a patient-centered way, facilitating shared decision-making in adult patients with AD,” the authors concluded.

References

1. Okereke R, Baghoomian W, Dunlap RR, et al. Development of a patient decision aid for atopic dermatitis systemic treatments in adults. JAMA Dermatol. Published online February 11, 2026. doi:10.1001/jamadermatol.2025.5912

2. Hoque F. Shared decision-making in patient care: advantages, barriers and potential solutions. J Brown Hosp Med. 2024;3(4):13-15. doi:10.56305/001c.122787

3. Morrison T, Johnson J, Baghoomian W, et al. Shared decision-making in dermatology: a scoping review. JAMA Dermatol. 2021;157(3):330-337. doi:10.1001/jamadermatol.2020.5362