Using a shared language to unlock better dermatological care

Doctors and patients are speaking a shared language to help improve the quality of life for patients living with chronic dermatological diseases.

Published October 1, 2019 / All Stories

Simple questions

When Murali Gopal, M.D., was a medical student, he sat in an examination room, listening as his mentor chatted with a patient about his plaque psoriasis—a chronic condition that can lead to painful, itchy or burning plaques on the skin. Instead of checking off a list of clinical questions, the doctor asked a startingly simple one.

Can you push your lawn mower?

Dr. Gopal, who is now vice president of global health economics and outcomes research for immunology at AbbVie, says the interaction profoundly altered his view on what helping patients really means. This patient took pride in a well-manicured lawn. By listening to him over the course of treatment, Dr. Gopal’s mentor learned this important bit of data. To understand if the prescribed treatment was helping, he needed to know if the man’s life was improving.

“Doctors can no longer say to a patient, ‘This is what you’ve got, this is what I’m giving you, goodbye,’” Murali said. “Now I think what you see is more of an acceptance to hear from the patient and a desire to know what matters to the patient in order to make joint decisions.”

Murali Gopal, M.D., is the vice president of global health economics and outcomes research for immunology at AbbVie.

Measuring what matters

Doctors have many measurement tools to help them better understand what patients are telling them. This type of information is called patient-reported outcomes, or PROs. These tools collect information on symptoms that affect how a disease impacts a person’s daily life, which patients can then report directly to their doctor during exams. Patients typically provide input in four different aspects of their quality of life: physical, emotional, social, and functional, says Chris Pashos, vice president of global evidence strategy at AbbVie, where he leads the patient-centered real-world evidence center of excellence. He explained that research shows PRO data is a helpful way to close the communication gap between patients and physicians by facilitating improved discussions about the burden of the disease on a patient’s life, which can help inform treatment decisions.

“In a physician’s office, the health care practitioner and the patient are often talking to each other in different languages,” Pashos said. “Patient-reported outcomes help each find a shared language.”

PROs can be especially important in dermatological diseases. In plaque psoriasis, for example, some outcomes, like lesions on the skin, are obvious to doctors. Other things that matter to patients, like itch, burn and pain, are not; yet, they can reduce a person’s quality of life in discouraging ways, such as the inability to take baths, wear sleeveless clothing or type on a keyboard. Patients have to tell their doctors about these symptoms and how they are affecting their daily activities or they may not be considered in their treatment plan.

“Patient-reported outcomes give such a comprehensive view of what’s going on with the patient in terms of how they’re being cared for, and that’s a really valuable perspective that can’t be ignored,” said Kris Fitzgerald, director of patient-centered outcomes at AbbVie.

Understanding immune system pathways

For patients living with chronic dermatological conditions, the symptoms on their skin are the result of things happening deep inside the body. Immune system pathways are opening new doors for the research community to explore ways of targeting and addressing immune-mediated diseases, such as psoriasis. PRO data can help connect the dots between reduced symptoms and increased quality of life, so that physicians and patients can better identify treatment goals and chart progress toward them.

For psoriasis, scientists and researchers have spent the past 20 years discovering answers to key immune system pathways. To understand the potential of these pathways, PRO data is key. AbbVie incorporated PRO data into its clinical trial program to understand how clinical outcomes relate to quality of life outcomes that are meaningful to patients.

“It’s critical that we continue our quest to better understand the unique aspects of diseases and treatments so that we can plan accordingly and act accordingly, whether we’re developing new drugs or whether we’re the health care practitioner sitting face-to-face with a patient,” Pashos said.

Chris Pashos, vice president of global evidence strategy at AbbVie, leads the patient-centered real-world evidence center of excellence.

Future tech in dermatology research

How can we use this data to help patients and physicians create goals and management plans that align with what is now possible due to advancements in treatments?

Streamlining PROs so that they are more commonly used in clinical practice and not just clinical trials is a starting point. The next frontier includes finding multiple ways to get input from patients. Pashos envisions a future where wearable devices improve the use and reliability of patient-provided data in both medicine development and clinical care.

“With PROs in clinical trials, there can be recall involved,” Pashos said. “With wearable technology, a device can actually measure what’s happening, and a lot of people think that the future of clinical trials will include greater use of these devices.”

Data from wearables, paired with powerful dialogue between patients and physicians, will be key to shaping and tracking progress in a patient’s treatment plan. So even with technology, Dr. Gopal’s mentor’s approach to patient conversation—finding a patient’s ‘lawnmower’ and remembering to ask if they can ‘push’ it—will always be important.

As for the patient Dr. Gopal observed, the answer to “can you push your lawnmower?” was now “yes.” Together with his doctor, they found a way to address his disease and help him resume a part of his life that is deeply important to him. He’s now back behind a lawnmower, taking pride in his yard, once again.

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