How do dermatologists' personal models inform a patient-centred approach to management: a qualitative study using the example of prescribing a new treatment (Apremilast)

Background The quality of dermatology consultations is partly determined by how clinicians approach patient care. The term 'Personal Models' describes the explanatory frameworks of thoughts, feelings and experiences that drive behaviour. One study found that clinicians' personal models, specifically their beliefs about autonomy and patient self-management, influenced the degree to which clinicians engage patients in shared decision making during consultations. Further research is needed to further explore how clinicians' personal models inform and affect the quality of patient care. Objectives To explore how clinicians' personal models inform shared decision making and consultation style in managing people living with psoriasis in the context of a new treatment, Apremilast. Methods A framework analysis of qualitative semi-structured telephone interviews with 13 dermatologists from the UK and Germany who participated in a novel medicine trial for psoriasis called APPRECIATE. Results Two themes were derived from the data. Theme 1, 'personal working models of patient care', comprised two subthemes: 'patient-centredness: a continuum' and 'stereotypes and assumptions'. Theme 2, 'impact of personal working models on patient care', included three subthemes: 'shared decision making: a continuum', 'consultation skills' and 'impact of concerns about Apremilast on prescribing behaviour'. Conclusions Although many dermatologists endorsed a patient-centred approach, not all reported working in this way. Clinicians' personal models, their beliefs, stereotypes, personal perceptions and assumptions about patients are likely to affect their prescribing behaviour and shared decision making. Additional specialized training and education could increase patient-centredness and whole-person management. What is already known about this topic? 'Personal models' is the term used to describe the thoughts, feelings and experiences that determine behaviour. Research has shown that clinicians' personal models can influence their approach to psoriasis management, although the evidence base is limited. What does this study add? Some, but not all, clinicians endorse a patient-centred approach. Clinicians' beliefs and attitudes about patients, psoriasis and evidence for psoriasis treatments all potentially influence the degree to which clinicians champion whole-person management. Clinicians' personal models impact how clinicians communicate with and behave towards patients during consultations and more specifically, the extent to which they demonstrate techniques to engage patients in joint decisions related to their condition and treatment. What are the clinical implications of this work? Additional specialized training and education could help clinicians to recognize how their beliefs, feelings and experiences influence their clinical practice, extend their skills in shared decision making, and facilitate whole-person management.

Automated summary

Personal models refer to the explanatory frameworks of thoughts, feelings, and experiences that drive behavior. Research has shown that clinicians' personal models can influence the degree to which they engage patients in shared decision making during consultations, thus impacting the quality of patient care.