urc mondor


Unité de Recherche Clinique Henri Mondor

Development of a shared decision-making tool in vitiligo: an international study.

Shourick J, Ahmed M, Seneschal J, Passeron T, Andreux N, Qureshi A, Chow EY, Natella PA, Harris J, Tran V-T, Ezzedine K Br J Dermatol. 2021;185(4):787-796.

BACKGROUND: Shared decision-making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology.

OBJECTIVES: To develop and validate a SDMt for use in specialized consultation for vitiligo.

METHODS: A prospective cross-sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision-making in the setting of a specialized consultation for vitiligo using an anchored-theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e-Delphi method.

RESULTS: We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision-making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English.

CONCLUSIONS: We developed a tool for shared decision-making in nonsegmental vitiligo, which we translated and cross-culturally validated in a US patient population with vitiligo to ensure its generalizability.

MeSH terms: Cross-Sectional Studies; Face; Humans; Prospective Studies; Skin Pigmentation; Treatment Outcome; Vitiligo
DOI: 10.1111/bjd.20137