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Vol. 110. Issue 2.
Pages 102-114 (March 2019)
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Vol. 110. Issue 2.
Pages 102-114 (March 2019)
Consensus Document
DOI: 10.1016/j.adengl.2019.01.012
Consensus Statement on the Psychological Needs of Patients With Chronic Inflammatory Skin Diseases
Documento de consenso sobre las necesidades psicológicas de los pacientes con enfermedades inflamatorias crónicas dermatológicas
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M. Riberaa,
Corresponding author
miquel.ribera@uab.cat

Corresponding author.
, S. Rosb, B. Madridc, R. Ruiz-Villaverded, F. Rebolloe, S. Gómeze, E. Lozaf, G. Carreterog
a Servicio de Dermatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
b Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
c Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
d Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
e Departamento médico de Pfizer, Alcobendas, Madrid, Spain
f Instituto de Salud Musculoesquelética, Madrid, Spain
g Servicio de Dermatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Tables (5)
Table 1. Levels of Evidence and Grades of Recommendation Defined by the Centre for Evidence-Based Medicine at the University of Oxford.
Table 2. Delphi Results for the Recommendations on the Psychological Needs of Patients with Chronic Inflammatory Skin Diseases.
Table 3. Areas That Should Be Considered When Assessing the Psychological Needs of Patients with Chronic Inflammatory Skin Diseases.
Table 4. Screening Questions Relating to the Most Important Psychological Symptoms for Consideration in Patients with Chronic Inflammatory Skin Diseases.
Table 5. Criteria for Referring Patients With Chronic Inflammatory Skin Diseases to a Mental Health Specialist.
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Abstract
Objective

To establish recommendations to determine, identify, and manage the psychological and emotional needs of patients with chronic inflammatory skin diseases in clinical practice.

Methods

A guided discussion was held at meeting of a nominal group of expert dermatologists and psychologists on the psychological and emotional needs of patients with chronic inflammatory skin diseases, how to manage these cases, and which referral criteria to employ. Based on the results of the discussion, and with the aid of a patient focus group and a review of the literature, a master document was drawn up with recommendations for discussion. A Delphi survey was circulated among a larger group of dermatologists and psychologists to assess the level of agreement with the recommendations.

Results

Ten recommendations were established and can be summarized as follows: explore the psychological sphere of the patients with open questions at the time of diagnosis and during the course of the disease; provide patients with clear explanations that address their concerns and inform them of the existence of patient associations; investigate symptoms of anxiety and depression and, if confirmed by means of a Hospital Anxiety and Depression score (HADS) of 11 or greater, consider referral to a mental-health specialist; and, during visits, create a climate of trust, empathize with patients, agree goals and treatment options with them, and motivate them to adhere to those treatments.

Conclusions

These recommendations may help health care professionals address psychological and emotional aspects of their patients in daily clinical practice.

Keywords:
Psoriasis
Atopic dermatitis
Psychological aspects
Clinical practice guidelines
Chronic dermatoses
Resumen
Objetivo

Establecer recomendaciones para conocer, identificar y manejar las necesidades psicológicas y emocionales de los pacientes con enfermedades inflamatorias crónicas dermatológicas en la práctica clínica habitual.

Métodos

En una reunión de grupo nominal con expertos dermatólogos y psicólogos, se realizó una discusión guiada sobre las necesidades psicológicas y emocionales de estos pacientes, cómo abordarlas, y cuáles serían los criterios de derivación apropiados. A partir de todo ello, con la ayuda de un grupo focal de pacientes y de una revisión de la literatura, se preparó un documento matriz con las recomendaciones para su discusión, así como una encuesta tipo Delphi para evaluar el grado de acuerdo con las mismas, que se hizo extensiva a más dermatólogos y psicólogos.

Resultados

Se establecieron 10 recomendaciones que podrían resumirse en las siguientes: explore la esfera psicológica de los pacientes con preguntas abiertas tanto en el momento del diagnóstico como durante el curso de la enfermedad. Dele explicaciones claras adaptadas a sus preocupaciones e infórmele de la existencia de asociaciones de pacientes. Explore si existen síntomas de ansiedad y depresión, y si se confirman mediantes una puntuación de 11 o más en la Hospital Anxiety and Depression Scale (HADS), valore una derivación a un especialista en salud mental. En las visitas, genere un clima de confianza, empatice con el paciente, consensúe con él los objetivos y opciones terapéuticas, y motívele para conseguir una buena adherencia.

Conclusiones

Estas recomendaciones pueden servir a los profesionales sanitarios para que aborden de forma abierta y natural aspectos psicológicos y emocionales del paciente en la consulta diaria.

Palabras clave:
Psoriasis
Dermatitis atópica
Aspectos psicológicos
Recomendaciones
Guías para la práctica clínica
Dermatosis crónicas

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