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\ud\udThe 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.\udAims & objectives\ud\udTo 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.\udMethods\ud\udA 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.\udResults\ud\udTwo themes were derived from the data. Theme one, personal working models of patient care, comprised of two sub-themes: (1.1) patient-centeredness: a continuum; and (1.2) stereotypes and assumptions. Theme two, impact of personal working models on patient care, included three sub-themes: (2.1) shared decision-making: a continuum; (2.2) consultation skills; and (2.3) impact of concerns about Apremilast on prescribing behaviour.\udConclusions\ud\udAlthough 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 specialised training and education could increase patient-centeredness and whole person management.