Shared Decision-Making Linked With Improved Treatment Satisfaction in Alopecia Areata

Patients with alopecia areata were less likely to report decisional regret regarding treatment when dermatologists incorporated shared decision-making, with prescription of Janus kinase (JAK) inhibitors associated with the lowest decisional regret.

Incorporating shared decision-making (SDM) was associated with reduced decisional regret regarding treatment among patients with alopecia areata (AA), according to study findings published in JAMA Dermatology.

AA, an autoimmune disorder of hair loss, has several therapeutic options that vary in efficacy and safety. Researchers note that the complex nature of AA treatment decision-making makes it difficult for patients to navigate, which increases reliance on their dermatologist’s guidance through SDM to make decisions that best align with their preferences.

“Implementation of SDM through decision aids may improve patient satisfaction and minimize decisional regret, defined as regretting the decision made regardless of the reason why,” they said. “Assessing the relationship between SDM and decisional regret may allow dermatologists to help patients choose treatment options that align with patients’ specific goals and risk tolerance.”

A cross-sectional survey study was conducted to determine patient preferences in SDM with their dermatologist during AA treatment decision-making, as well as what aspects of their involvement and which treatment decisions are associated with lower decisional regret and improved satisfaction.

The analysis included patients with AA using the National Alopecia Areata Foundation (NAAF) listservs from July 12, 2021, to August 2, 2021, who were evaluated via the validated 9-item Shared Decision Making Questionnaire (SDMQ9), Control Preferences Scale, and Decisional Regret Scale (DRS) on several measures:

  • Patient preferences in SDM when making treatment decisions
  • How patients perceived the last decision to have been made
  • Which components of SDM were incorporated into the last decision
  • Decisional regret related to their last treatment decision

Of the 1387 individuals who initiated the survey, 1074 (mean [SD] age, 49.3 [15.4] years; mean (SD) disease duration, 17.7 [15.4] years; 77.8% White [n = 836]; 85.4% [n = 917] female) completed it and were included in the analysis (77.4% completion rate). A total of 5 American Indian or Alaska Native respondents (0.5%), 33 Asian (3.1%), 112 Black or African American (10.4%), and 36 multiracial (3.4%) or other (36 [3.4%]) patients were included.

Overall, most respondents preferred making the final treatment decision themselves after considering their physician’s opinion (n = 503 [46.8%]). Of these patients who preferred making treatment decisions using SDM, a majority made the last AA treatment decision with their physician (n = 596 [55%]; 95% CI, 53%-58%; P < .001).

Two components of SDM most identified to be part of patients’ last AA treatment decision were that their physician “explained the advantages and disadvantages of treatment options” (472 [44%] completely or strongly agreed) and “asked me which treatment option I prefer” (494 completely or strongly agreed [45.9%]).

All components of SDM were shown to be associated with decreased decisional regret (all ORs with 95% CIs greater than 1.1; P < .01), except for “Doctor made clear that a decision needs to be made” (OR, 1.45; 95% CI, 0.88-2.37; P = .14).

Regarding treatments associated with the lowest decisional regret, Janus kinase (JAK) inhibitors came first, followed by biologics and deciding not to treat. Conversely, the highest decisional regret was reported with anthralin and minoxidil.

As patients ​​recruited from the NAAF may not be representative of all patients with AA, researchers said that the findings could be affected by selection bias. Other limitations cited included the study’s female White majority cohort and the lack of data on whether disease severity or highly efficacious treatments affected risk of decisional regret.

“Future studies should seek to devise solutions for structured implementation of SDM during the AA treatment decision-making process, especially as the AA treatment landscape evolves,” concluded the study authors.


Reyes-Hadsall S, Drake L, Han JJ, et al. Shared decision-making, therapeutic choice, and decisional regret in patients with alopecia areata. JAMA Dermatol. Published online August 17, 2022. doi:10.1001/jamadermatol.2022.3025

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