EMPATHY Algorithm Aims to Improve Care for Patients with Moderate to Severe Psoriasis

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Created by a team of 14 dermatologists and one psychologist, the EMPATHY (Embracing Patients’ Wellbeing in Their Journey of Moderate-to-Severe Psoriasis) algorithm was designed to provide a new and promising approach to improving patient care and wellbeing—while considering in-office time constraints—among patients with moderate to severe psoriasis.

“The complexity of psoriasis necessitates a multidisciplinary and personalized approach to care,” wrote a team of investigators led by Francesca Prignano, M.D., Ph.D, professor in Dermatology at the University of Florence, Italy. “Patients with psoriasis may benefit from a specialist coordination of care that addresses their overall mental, emotional and physical health. However, a notable gap still exists in terms of implementing this approach in routine clinical practice.”

The team focused on the role empathy plays in improving patient care for conditions like psoriasis using data from two recent studies. The SHAring Patient Experiences (SHAPE) study investigated the challenges faced in achieving good quality of life using a nationwide survey distributed in Italy. The project demonstrated a clear gap between treatment desires and the perception of disease among patients. These patients also felt their dermatologist was not considerate of their wellbeing and may potentially underestimate the social and psychological burden of these patients.

A follow-up study surveyed Italian dermatologists and found that while clinicians did prioritize the quality of life of their patients, patient satisfaction continued to be a challenge. Results indicated the need for tailored algorithms and a collaborative effort between dermatologists and psychologists to enhance care.

The EMPATHY Algorithm

The EMPATHY algorithm was developed during 3 separate meetings in which the team described a patient’s reception during the initial visit and follow-ups in an effort to provide clinicians with practical guidance regarding appointment protocol.

The step-by-step approach fosters empathy by outlining patient-centered strategies for each visit. These include cultivating a comfortable environment, using active listening, individualizing communication styles, respecting a patient’s privacy, and managing patient expectations.

The First Visit

During the initial visit, patients should be greeted with a relaxed waiting area with comfortable temperatures and a place to sit. They should be provided with scientific information that can help create a sense of familiarity and trust in their specialist’s area of expertise.

The front office staff plays a vital role in this process, as their reception should be welcoming and reassuring. Questionnaires can also optimize these visits, as clinicians can use them to steer the appointment.

Patient Interaction

The algorithm emphasizes simple gestures like inviting a patient to sit down, maintaining eye contact, and providing a dedicated consultation space to ensure privacy. Tailoring the management of the visit and way of speaking according to each patient is also important, as is avoiding bias and maintaining a nonjudgmental attitude. Investigators stress being able to recognize a patient’s suffering and its extent is crucial, using both verbal and nonverbal cues.

During the skin examination, the team recommends a full-body examination to demonstrate comprehensive care and begin to build trust with the patient. If a person is nervous or anxious, the clinician should take the time to put them at ease.

Once a treatment strategy has been established, investigators emphasize the importance of managing expectations, including timelines, common adverse events, and that not all patients respond to therapy in the same way. At the end of the initial visit, the clinician should ask the patient how they are feeling and if they thought anything was missed during the examination.

Subsequent Visits

Follow-up visits are an excellent opportunity to nurture the relationship between patient and clinician. This can be achieved by engaging in casual conversation and asking questions, such as a patient’s satisfaction with their treatment, changes since the last visit, and general mood.

If a patient has not improved or is not feeling well, clinicians should make appropriate decisions based on the new evidence, which may include changing the treatment plan if necessary. Lack of response with one therapy should not be viewed as a “failure” but rather as an opportunity to start fresh.

“While further validation is necessary, the potential for adapting the EMPATHY algorithm to diverse healthcare settings and patient populations holds promise for improving patient outcomes across various chronic conditions,” investigators concluded.