Shared decision-making in psoriasis care: a retrospective self-report survey of decision-making preparedness, satisfaction, and anxiety in Taiwan

Psoriasis is a chronic inflammatory skin disease that significantly impairs patients’ quality of life. Shared decision-making (SDM) enhances patient involvement in care but is underutilized in psoriasis management. The objective of this study is to develop a tailored SDM program for psoriasis patients in Taiwan and evaluate its feasibility, acceptability, and preliminary associations with perceived decision-making preparedness, satisfaction with clinician communication, self-reported decision-related anxiety, and treatment decision completion. A multidisciplinary team created an SDM program and paper-based patient decision aid (PDA) for adult patients with moderate-to-severe plaque psoriasis considering biologic treatments. In this retrospective single-group self-report survey, 72 patients completed a post-SDM questionnaire, including assessing perceived preparedness using the Preparation for Decision Making (PrepDM) scale and satisfaction with clinician communication using the CollaboRATE scale. Patients also retrospectively reported their pre-SDM decision status and self-reported decision-related anxiety in the same questionnaire and then reported their post-SDM status after the PDA-guided consultation. After the SDM consultation, the mean PrepDM score was 78.4 ± 21.0 out of 100, suggesting a high level of perceived decision-making preparedness, while the mean CollaboRATE score was 90.4 ± 12.3 out of 100, reflecting high satisfaction with clinician communication. The proportion of patients reporting that they had made a treatment decision by the end of consultation increased from 4.2% before SDM to 86.1% after SDM ( p < 0.001). Elevated self-reported decision-related anxiety decreased from 52.8% before SDM to 33.3% after SDM ( p = 0.029). In this retrospective single-group self-report survey, a culturally adapted SDM program for biologic treatment selection in psoriasis was feasible to implement and was associated with high perceived decision-making preparedness, high satisfaction with clinician communication, increased decision completion, and lower self-reported decision-related anxiety immediately after SDM. These findings should be cautiously interpreted as preliminary and hypothesis-generating. Further prospective controlled studies using validated decisional quality and anxiety measures are needed before causal conclusions or broader implementation recommendations can be made. Not applicable.