Shared decision-making in severe asthma therapy: qualitative study of physician-patient communication.

Rationale: Biologics are indicated for severe asthma, but little is known about the factors driving patient and physician decisions surrounding their use.

Objectives: To understand decision drivers for biologic use and conversational dynamics between patients with severe asthma and physicians.

Methods: This retrospective database study used anonymized physician-patient conversations (recorded September 2018-August 2020) from routine clinical visits, captured in Verilogue's physician-patient syndicated database. Eligible conversations included those of patients with severe asthma, who were considering biologic therapy (Topic 1), had initiated biologic within 7 months of clinical visit (Topic 2), or were discontinuing/considering switching biologic treatment (Topic 3). Conversations were analyzed quantitatively and descriptively by topic.

Results: Overall, 50 conversations between 14 physicians and 50 patients were included (considering biologic, n = 10; recent biologic initiation, n = 20; switched/discontinued biologic, n = 20). Physicians had 68-73% share of the conversation. When considering biologic treatment, the presence of symptoms (including coughing, wheezing, shortness of breath and chest tightness) drove the decision, with 3/10 patients providing additional symptom impact/severity details, and 2/10 describing adjustments to accommodate symptoms. Physicians set unspecified treatment goals and modest expectations for biologic efficacy, framing any symptom control as success (13/20 conversations). Patient symptom assessment drove the decision to continue, discontinue, or switch biologic treatment: in 5/20 cases, physicians asked patients if they were "better" or the medication is "helping."

Conclusions: This study suggests that patients relied on physicians to shape patient-physician interactions and treatment expectations. This suggests that shared decision-making may improve physicians' understanding of the impact severe asthma has on patients and facilitate the setting of treatment expectations.