Patients preferences

One alleged difficulty with conducting randomised clinical trials in dermatology is the visibility of skin lesions and the consideration that, much more so than in other areas, patients self-monitor their disease and may have preconceptions and preferences about specific treatment modalities.22 The decision to treat is usually dictated by subjective issues and personal feelings. There is a need to educate physicians and the public about the value of randomised trials to assess interventions in dermatology. Motivations and expectations are likely to influence clinical outcomes of all treatments, but they may have a more crucial role in situations where "soft" endpoints matter, as in dermatology. Commonly, more than 20% of patients with psoriasis entering randomised clinical trials experience improvement on placebo independently of the initial disease extent. Motivations are equally important in pragmatic trials where different packages of management are evaluated, such as in the comparison of a self-administered topical product for psoriasis with hospital-based therapy like phototherapy. Traditionally, motivation is seen as a characteristic of the patient that is assumed not to change with the nature of the intervention. However, it has been argued that it is more realistic to view motivation in terms of the "fit" between the nature of the treatment and the patient's wishes and perceptions, especially with complex interventions that require the patient's active participation.23 The public is inundated with uncontrolled and sometimes misleading or unrealistic messages on how to improve the body's appearance. All in all, there is a need to ensure that patient information and motivation are properly considered in the design and analysis of clinical trials on skin disorders.

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