JMIR Publications

ABSTRACT

Background:

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 to enable robust comparisons among treatment options, but NMA results are often complex and difficult to directly implement in shared decision making.

Objective:

To develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users.

Methods:

We conducted a multi-method study using iterative feedback from adults with AD and adult caregivers of children with AD and dermatologists and allergists within a user-centred 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.

Results:

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 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). Four patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. 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.

Conclusions:

We developed a website, www.eczematherapies.com, with a user-centred design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process.