Bridging the Perception Gap: Understanding Discordant Severity Grading in Eczema and Psoriasis

A recent study published in JAMA Dermatology shed light on the often-discordant perceptions of disease severity in patients with eczema and psoriasis when compared to their physicians. This phenomenon, known as discordant severity grading (DSG), has long been a challenge in dermatologic practice, potentially hindering the patient-physician relationship and leading to frustration on both sides.

The study aimed to develop a theoretical model that could explain the cognitive, behavioral, and disease-related factors contributing to DSG. Once this theoretical model was established, the study proceeded to a prospective cross-sectional quantitative phase, in which structural equation modeling (SEM) was used to validate the model's findings.

A total of 1053 patient-physician pairs participated in this study, with patients ranging in age from 18 to 99 years and having a minimum disease duration of 3 months. The primary outcome measured was the discrepancy between the global disease severity, rated on a 0-to-10 numeric scale, as assessed by the patient and their attending dermatologist.

The results of the study revealed that a significant portion of patient-physician pairs, approximately 46.3%, exhibited some form of DSG. Notably, 42.4% of these cases were categorized as positive discordance, where patients rated their disease as more severe than their physicians did. Conversely, 3.8% displayed negative discordance, with patients rating their condition as less severe than their physicians' assessments.

SEM played a crucial role in understanding the factors contributing to discordance. Positive discordance was found to be associated with higher symptom expression and a more substantial impact on the patient's quality of life. Importantly, demographic factors, whether related to the patient or physician, did not significantly influence discordance. Instead, the study uncovered a web of interconnected factors, including quality-of-life impairment, resilience, social comparisons, self-efficacy, disease cyclicity, and expectations of chronicity.

“This cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance,” concluded the study authors.

Reference
Long V, Chen Z, Du R, et al. Understanding discordant perceptions of disease severity between physicians and patients with eczema and psoriasis using structural equation modeling. JAMA Dermatol. 2023;159(8):811-819. doi:10.1001/jamadermatol.2023.2008