Shared decision making in severe asthma therapy: qualitative study of physician-patient communication

Abstract

Introduction: Treatment for severe asthma with biologics is increasing, however factors driving use are still unknown.

Aim: To understand decision drivers and conversational dynamics between healthcare providers (HCPs) and their patients with severe asthma.

Methods: Anonymized audio recordings of routine visits in the US, from Sept 2018 to Oct 2020, between HCPs and their patients regarding biologics were retrospectively analyzed for the following decision points: 1. Start of therapy, 2. Follow-up visit, 3. Switch/discontinuation (DC).

Results: 50 conversations (10 at start, 20 at follow-up, 20 at switch/DC) were analyzed from 14 unique HCPs (11 allergists, 3 pulmonologists). At all decision points HCPs spoke at least twice the time of the patient.

At start of therapy, HCPs tended to position biologics as “highly effective injectable treatments” (5/10). HCPs did not set specific goals for biologic treatments, instead broadly promising they will “improve” symptoms. Patients rarely expressed their own goals.

At follow-up visits, the decision to stay on biologics is mostly patient-driven. HCPs frequently invited patients’ assessment of symptom improvement and treatment satisfaction. In 7/20 conversations, HCPs asked the patient about side-effects post-biologic treatment, which in some cases triggered a switch/DC.

Switch/DC visits were often driven by patients’ symptom characterization. If switching to another biologic, HCP’s were, again, cautious about providing treatment goals.

Conclusions: Encouraging more patient participation in setting treatment goals, in discussion with their HCP, can improve the decision process to start, continue or DC biologic therapy.

Funding: GSK (213865)