Findings

Providing psychosocial support

Providing psychosocial support

What is the challenge?
  • AD has been associated with a number of mental health conditions, including depression and anxiety(a)
  • Even if not manifesting into a clinical diagnosis, the burden associated with AD (e.g. due to stigma, access to treatment, travel to consultations) can negatively impact patients’ wellbeing, who may benefit from psychosocial support(b)
Enabling access to psychosocial support to help patients manage the burden and impact of AD on their psychological, emotional and social wellbeing
What is the goal/s of the intervention?
  • Reduce the burden and impact of having AD on patients, and promote better adherence to treatment
  • Empower patients with the opportunity to self-manage the psychological aspects of their disease
  • Enhance the QoL for AD patients, by addressing problems such as stigma and bullying
  • Provide holistic support to patients across multiple aspects of daily life, such as managing the impact of AD on sleep and occupation
Who is often involved in the intervention?
  • Dermatologist
  • Nurse/medical assistant
  • Psychologist
  • Social worker
  • Psychiatrist
  • Physiotherapist
  • Patient Group
  • Primary care practitioner (PCP)
  • Occupational health physician
What are the potential outcomes?

Patients

  • Recognition of psychosocial impact of AD and early identification of psychological comorbidities, resulting in improved self/HCP management
  • Access to a network of peers, providing the opportunity to share experiences
  • Increased public and professional awareness of the stigma experienced by patients with visible skin diseases
  • Reduction in physical manifestations that result from low psychosocial management, such as stress, scratching and unhelpful coping mechanisms

HCPs

  • Improved knowledge regarding psychosocial burden and correct management
  • Reduced burden for HCPs through patients better self-managing their disease

Healthcare system

  • Potential prevention of worsening of associated mental health complications that arise and may impact other areas of care(c)
(a)

Slattery MJ, et al. Depression, anxiety, and dermatologic quality of life in adolescents with atopic dermatitis. J Allergy Clin Immunol. 2011;128(3):668–671. doi:10.1016/j.jaci.2011.05.003;

(b)

Zuberbier T, et al. Patient perspectives on the management of atopic dermatitis. Journal of Allergy and Clinical Immunology. 2006; 118(1):226-32;

(c)

Spielmanman S, et al. A review of multidisciplinary interventions in Atopic Dermatitis. Journal of Clinical medicine. 2015;4(5):1156-1170. doi: 10.3390/jcm4051156

What is offered as part of the intervention?
  • Assessing impact of AD on a patient’s psychosocial wellbeing
  • Providing psychological/emotional support:
    • Talking therapy (e.g. Cognitive Behavioural Therapy [CBT], Short-term Scheme Therapy)
    • Habit reversal techniques
    • Access to medication (e.g. antidepressants)
    • Sleep/relaxation techniques
    • Managing impact on personal relationships (e.g. providing couple’s counselling)
  • Providing social support with:
    • Housing
    • Employment
    • Finances
    • Access to treatment (e.g. prior authorisation with insurance companies)
  • Triaging of patients to other psychosocial professionals (depending on needs)
  • Providing access to peer-to-peer support (i.e. from other AD patients) via group education or Patient Groups
How has the intervention been implemented in different centres?

Note:    With input from the steering committee, we have categorised these activities by level of resource required to implement, and whether they are likely to be delivered by all HCPS or psychosocial professionals specifically. The level of resources required may vary across centres/settings (e.g. depending on existing resources)

EASY
All HCPs
  • Recognising burden of AD and impact on patient QoL in consultations
  • Identifying psychosocial specialist/department to refer patients to and/or receive guidance from (e.g. via telephone or email) at centre or externally, regarding provision of management
  • Assessing patients’ wellbeing during standard consultations with informal questioning (e.g. mood, anxiety, sleep) and identifying patients in need of psychosocial support
  • Directing patients to peer-to-peer support groups at centre or externally (e.g. by Patient Groups)
Psychosocial professional (specifically)
  • n/a
MEDIUM
All HCPs
  • Establishing specialist nurses (e.g. Advanced Nurse Practitioners (ANPs), study nurses) who are able to provide longer and more frequent 1:1 consultations to discuss psychosocial burden with patients
  • Attending training to increase awareness of psychosocial impact of AD
  • Using validated PRO measures (e.g. DLQI) to screen or assess patient outcomes
  • Providing patient group education (for peer-to-peer support)
Psychosocial professional (specifically)
  • Providing 1:1 patient consultations at centre, or joint consultations in collaboration with a AD specialist (i.e. patient would see dermatologist and psychologist in the same consultation)
  • Attending multidisciplinary team (MDT) meetings to provide specialist psychosocial advice and review case studies
  • Co-delivering patient group education (with other HCPs, to provide psychosocial related information/support)
ADVANCED
All HCPs
  • Creating the role of patient coordinator/case manager to support patients with the psychosocial burden
  • Conducting research to raise awareness of stigma associated with AD
  • Recommending interventions (e.g. mobile phone applications, music therapy) to support patients with relaxation and management of itch
Psychosocial professional (specifically)
  • Developing education programmes for HCPs regarding provision of psychosocial support
  • Developing interventions (e.g. mobile phone applications, music therapy) to support patients with relaxation and management of itch
Relevant centre case studies

Providing access to psychosocial professionals

Dedicated social worker, UMC Utrecht, Netherlands

Joint psychiatry-dermatology clinics, CHRU Brest, France

Onsite dermatology psychologist, Hospital Sant Pau (Barcelona), Spain

Onsite psychologist, CHRU Brest, France

Onsite specialist in psychosomatic medicine and psychotherapy, UKSH (Kiel), Germany

Paediatric psychology group sessions, University of São Paulo Hospital, Brazil

Patient psychological support, University of São Paulo Hospital, Brazil

Prior authorisation nurse role, OHSU (Oregon), USA

Provision of psychological care, UNIMORE (Modena), Italy

Psycho-derm clinic, Royal Devon & Exeter Hospital, UK

Psycho-social care network, UMC Groningen, Netherlands

Role of clinical service coordinator, Hospital La Paz (Madrid), Spain

Role of the occupational health physician, Aarhus Universitetshospital, Denmark

Comorbidity management, CH Lyon-Sud, France

Paediatric and adult psychological support, University of São Paulo Hospital, Brazil

Psychological support, Cayre Clinical Center, Colombia

Providing patient group education (for peer-to-peer support)

AD patient educational evenings, Inselspital (Bern), Switzerland

Eczema School, Aarhus Universitetshospital, Denmark

Interactive support groups, Medical Dermatology Associates of Chicago, USA

Multidisciplinary group based education programme, UKSH (Kiel), Germany

Nurse-led patient education, Linkou Chang Gung Memorial Hospital (Taipei), Taiwan

Allergy Camp, Dokkyo Medical University Hospital, Japan

Patient/family educational workshops, Hospital La Paz (Madrid), Spain

Patient and family education, Hospital Sant Pau (Barcelona), Spain

Patient forum, Linkou Chang Gung Memorial Hospital (Taipei), Taiwan

Provision of group therapeutic education, CHRU Brest, France

Establishing specialist nurses (e.g. Advanced Nurse Practitioners (ANPs), study nurses) who are able to provide longer and more frequent 1:1 consultations

Dermatology Advanced Nurse Practitioner (ANP), UMC Utrecht, Netherlands

Enhanced role of the nurse, UMC Groningen, Netherlands

Enhanced role of the nurse, Women’s College Hospital (Toronto), Canada

Nurse shared responsibilities, Aarhus Universitetshospital, Denmark

Role of the Advanced Nurse Practitioner (ANP), Inselspital (Bern), Switzerland

Specialist study nurses, UKSH (Kiel), Germany

Developing interventions to support patient’s with relaxation and management of itch etc.

Music therapy trial, CHRU Brest, France

Physiotherapist relaxation and mobile app, Inselspital (Bern), Switzerland

Provision of group therapeutic education, including “Walk of Skin” game, CHRU Brest, France

Conducting research to raise awareness of stigma associated with AD

Involvement in anti-stigmatisation study, CMSS (Selters), Germany

Involvement in anti-stigmatisation study, UKSH (Kiel), Germany

Using validated PRO measures (e.g. DLQI) to screen or assess patient outcomes

Bespoke patient reported outcome (PRO) assessment, OHSU (Oregon), USA

Structured patient assessment tool, UKSH (Kiel), Germany