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What patients with psoriasis believe about their condition
Letters"
J AM ACAD DERMATOL VOLUME 41, NUMBER2, PART 1
imply that optimal care requires the p r o p o s e d schedule of laboratory monitoring. Dr Kanzler asserts that sentinel lymph node biopsies have not b e e n shown to be therapeutic or conclusively prognostic. We agree with his assertion. In our experience, most patients who enter our programs are aware of the p r o c e d u r e and do inquire about its relevance to their care. To our knowledge, many major centers now offer sentinel lymph node biopsies or are in the process of establishing a competent unit. We assumed for the m o d e l that most follow-up visits would qualify for at least a level 3 visit. Clearly, situations do arise w h e r e a higher level may be appropriate. It is up to the individual physician to properly d o c u m e n t a level 4 or level 5 visit if they provide that level of service and bill their insurance c o m p a n i e s accordingly. If follow-up is put in the m o d e l at a higher level than level 3, it does not appreciably change the annual cost of m e l a n o m a management. The bulk of cost is incurred by surgery, adjuvant therapy, and late-stage management. In summary, our model is intended to reflect the current status of and developing trends in melanoma m a n a g e m e n t . Our goal is a first approximation of annual US health care costs attributable to this cancer. We do not intend the model to function as a critical pathway derived from exhaustive analysis of existing medical evidence.
Hensin Tsao, MD, PhDa Arthur J. Sober, MDa Gary S. Rogers, MD b
and their source of this information. Patients attending a specialist psoriasis clinic in California À and British teaching and district general hospitals 2 were investigated. Broadly similar results were seen at all 3 centers; the majority of patients were aware of core facts about the disease. In the UK study, 71% of patients a g r e e d that hereditary and genetic factors w e r e i m p o r t a n t in psoriasis, c o m p a r e d with 60% of the Manchester patients' beliefs. In the California population, followup patients had higher knowledge scores than new patients, although this was not seen in the UK study. Patients n o w expect to be m o r e i n f o r m e d a b o u t their condition, and there are several sources to provide this information. It would be interesting to k n o w w h e t h e r the responses of patients in the study by Fortune et al were influenced by their factual knowledge of psoriasis, perhaps comparing new patients with follow-up patients. Presumably attendance at a tertiary referral center has resulted after previous exposure to doctors with s o m e experience of psoriasis. In the study of UK patients, age, duration of psoriasis, and number of admissions to hospital did not influence scores, suggesting that patients do not significantly increase their knowledge of psoriasis the longer they have it. It may be that knowledge levels concerning their disease have a greater influence on patients' beliefs and s y m p t o m s than the overall clinical severity of psoriasis.
S. W. Lanigan, MD. FRCP,DCH Consultant Dermatologist Department of Dermatology Princess of Wales Hospital Coitv Road, Bridgend CF31 1RQ, UK
Department of Dermatology Harvard Medical School Massachusetts General Hospital Boston, Massachusetts a Department of Surgery Boston University Medical Center Boston, Massachusetts ~5
What patients with psoriasis believe about their condition 76 lhe Editor: I am e n c o u r a g e d by the r e p o r t of Fortune and colleagues that patients with psoriasis attending a tertiary referral clinic are knowledgeable a b o u t the cause of their condition 0 Am Acad Dermatol 1998;39:196-201). Patients' beliefs about their psoriasis must be related to their factual knowledge concerning their disease. As the authors attest, these beliefs in turn are of fundamental importance in adjusting to their condition. 1 have been interested in the level of knowledge that patients with psoriasis have about their disorder
283
REFERENCES 1. Lanigan SW, Farber EM. Patients' knowledge of psoriasis: pilot study. Cutis 1990;46:359-62. 2. Lanigan SW, Layton A. Level of knowledge and information sources used by patients with psoriasis. Br J Dermatol 1991, t 25:340-2.
Reply To the Editor: We were pleased to see that our recent study 1 generated some interest a m o n g clinicians. In particular, Dr Lanigan poses some useful questions a b o u t the links b e t w e e n knowledge, beliefs, and adjustment. These questions have been of interest for some time, and research has demonstrated the d e s y n c h r o n y b e t w e e n beliefs and k n o w l e d g e in patients with chronic medical conditions. For example, research in hypertension has shown that sim-
J AM ACAD DERMATOL VOLUME 41, NUMBER2, PART 1
imply that optimal care requires the p r o p o s e d schedule of laboratory monitoring. Dr Kanzler asserts that sentinel lymph node biopsies have not b e e n shown to be therapeutic or conclusively prognostic. We agree with his assertion. In our experience, most patients who enter our programs are aware of the p r o c e d u r e and do inquire about its relevance to their care. To our knowledge, many major centers now offer sentinel lymph node biopsies or are in the process of establishing a competent unit. We assumed for the m o d e l that most follow-up visits would qualify for at least a level 3 visit. Clearly, situations do arise w h e r e a higher level may be appropriate. It is up to the individual physician to properly d o c u m e n t a level 4 or level 5 visit if they provide that level of service and bill their insurance c o m p a n i e s accordingly. If follow-up is put in the m o d e l at a higher level than level 3, it does not appreciably change the annual cost of m e l a n o m a management. The bulk of cost is incurred by surgery, adjuvant therapy, and late-stage management. In summary, our model is intended to reflect the current status of and developing trends in melanoma m a n a g e m e n t . Our goal is a first approximation of annual US health care costs attributable to this cancer. We do not intend the model to function as a critical pathway derived from exhaustive analysis of existing medical evidence.
Hensin Tsao, MD, PhDa Arthur J. Sober, MDa Gary S. Rogers, MD b
and their source of this information. Patients attending a specialist psoriasis clinic in California À and British teaching and district general hospitals 2 were investigated. Broadly similar results were seen at all 3 centers; the majority of patients were aware of core facts about the disease. In the UK study, 71% of patients a g r e e d that hereditary and genetic factors w e r e i m p o r t a n t in psoriasis, c o m p a r e d with 60% of the Manchester patients' beliefs. In the California population, followup patients had higher knowledge scores than new patients, although this was not seen in the UK study. Patients n o w expect to be m o r e i n f o r m e d a b o u t their condition, and there are several sources to provide this information. It would be interesting to k n o w w h e t h e r the responses of patients in the study by Fortune et al were influenced by their factual knowledge of psoriasis, perhaps comparing new patients with follow-up patients. Presumably attendance at a tertiary referral center has resulted after previous exposure to doctors with s o m e experience of psoriasis. In the study of UK patients, age, duration of psoriasis, and number of admissions to hospital did not influence scores, suggesting that patients do not significantly increase their knowledge of psoriasis the longer they have it. It may be that knowledge levels concerning their disease have a greater influence on patients' beliefs and s y m p t o m s than the overall clinical severity of psoriasis.
S. W. Lanigan, MD. FRCP,DCH Consultant Dermatologist Department of Dermatology Princess of Wales Hospital Coitv Road, Bridgend CF31 1RQ, UK
Department of Dermatology Harvard Medical School Massachusetts General Hospital Boston, Massachusetts a Department of Surgery Boston University Medical Center Boston, Massachusetts ~5
What patients with psoriasis believe about their condition 76 lhe Editor: I am e n c o u r a g e d by the r e p o r t of Fortune and colleagues that patients with psoriasis attending a tertiary referral clinic are knowledgeable a b o u t the cause of their condition 0 Am Acad Dermatol 1998;39:196-201). Patients' beliefs about their psoriasis must be related to their factual knowledge concerning their disease. As the authors attest, these beliefs in turn are of fundamental importance in adjusting to their condition. 1 have been interested in the level of knowledge that patients with psoriasis have about their disorder
283
REFERENCES 1. Lanigan SW, Farber EM. Patients' knowledge of psoriasis: pilot study. Cutis 1990;46:359-62. 2. Lanigan SW, Layton A. Level of knowledge and information sources used by patients with psoriasis. Br J Dermatol 1991, t 25:340-2.
Reply To the Editor: We were pleased to see that our recent study 1 generated some interest a m o n g clinicians. In particular, Dr Lanigan poses some useful questions a b o u t the links b e t w e e n knowledge, beliefs, and adjustment. These questions have been of interest for some time, and research has demonstrated the d e s y n c h r o n y b e t w e e n beliefs and k n o w l e d g e in patients with chronic medical conditions. For example, research in hypertension has shown that sim-