Lau Karen P L, Agarwal Payal, Parente Laura, Marcello Olivia, Lovas Mike, Van Jason, Vigod Simone N, Champagne Trevor, Mohan Tanya, Arents Bernd Wm, Burton Tim, Flohr Carsten, Drucker Aaron M
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
JMIR Dermatol. 2022 Sep 26;5(3):e41201. doi: 10.2196/41201.
A rapid expansion of systemic immunological treatment options for atopic dermatitis (AD) has created a need for clinically relevant and understandable comparative efficacy and safety information for patients and clinicians. Given the scarcity of head-to-head trials, network meta-analysis (NMA) is an alternative way to enable robust comparisons among treatment options; however, NMA results are often complex and difficult to directly implement in shared decision-making.
The aim of this study is to develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users.
We conducted a multimethod study using iterative feedback from adults with AD, adult caregivers of children with AD, dermatologists, and allergists within a user-centered design framework. We used questionnaires followed by workshops among patients and clinicians to develop and improve the website interface. Usability testing was done with a caregiver of a patient with eczema.
Questionnaires were completed by 31 adults with AD or caregivers and 94 clinicians. Patients and caregivers felt it was very important to know about new treatments (20/31, 65%). Clinicians felt the lack of evidence-based comparisons between treatments was a barrier to care (55/93, 59%). "Avoiding dangerous side effects" was ranked as the most important priority for patients (weighted ranking 5.2/7, with higher ranking being more important), and "improving patients' overall symptoms" was the most important priority for clinicians (weighted ranking 5.0/6). A total of 4 patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. The patients suggested changes to simplify the interface and clarify terminology related to comparative efficacy. The user in the usability testing found the website intuitive to navigate.
We developed a website, "eczematherapies.com," with a user-centered design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process.
特应性皮炎（AD）全身免疫治疗选择的迅速扩展，使得患者和临床医生需要获得具有临床相关性且易于理解的比较疗效和安全性信息。鉴于头对头试验的稀缺性，网状Meta分析（NMA）是在不同治疗选择之间进行有力比较的一种替代方法；然而，NMA结果往往很复杂，难以直接应用于共同决策。
本研究的目的是开发一个网站，向患者和临床医生用户有效展示关于AD治疗的动态系统评价和NMA结果。
我们在以用户为中心的设计框架内，采用来自成年AD患者、AD患儿的成年照料者、皮肤科医生和过敏症专科医生的迭代反馈，进行了一项多方法研究。我们先使用问卷，然后在患者和临床医生中举办研讨会，以开发和改进网站界面。对一名湿疹患者的照料者进行了可用性测试。
31名成年AD患者或照料者以及94名临床医生完成了问卷。患者和照料者认为了解新治疗方法非常重要（20/31，65%）。临床医生认为治疗之间缺乏基于证据的比较是护理的一个障碍（55/93，59%）。“避免危险的副作用”被患者列为最重要的优先事项（加权排名5.2/7，排名越高越重要），而“改善患者的整体症状”是临床医生最重要的优先事项（加权排名5.0/6）。共有4名患者和7名临床医生参加了研讨会；他们欣赏NMA结果的可视化展示，并发现该网站对于比较不同治疗方法很有价值。患者建议进行更改以简化界面并澄清与比较疗效相关的术语。可用性测试中的用户发现该网站导航直观。
我们采用以用户为中心的设计方法开发了一个网站“eczematherapies.com”。NMA结果的可视化展示使用户能够在共同决策过程中比较治疗方法。
