LIVING WITH ALLERGIES STUDY: AN EXPLORATORY STUDY TO UNDERSTAND ADULT PATIENT EXPERIENCES, ADHERENCE BARRIERS AND PREFERENCES RELATED TO TREATMENTS FOR ALLERGIC RHINOCONJUNCTIVITIS

Background:   Allergy immunotherapy (AIT) is recommended for patients with moderate/severe allergic rhinoconjunctivitis (AR) who cannot find adequate symptom relief from allergy avoidance or pharmacological treatments. AIT can be administered subcutaneously (allergy shots), or sublingually (drops or tablets).  The literature suggests that a shared decision making approach to allergy care (SDM): 1) could help inform patients’ decision to start AIT; 2) could help select the treatment option that best matches their preferences, needs and expectations; and 3) that patient-treatment matching may improve adherence/persistence – essential to realizing clinical benefit.  Understanding what is needed for shared decision making in AIT requires insight into “the black box” of allergist-patient communication.

Purpose:   The purpose of this study was to comprehensively identify factors that influence decision making about AIT and other treatments for AR among adult patients eligible for AIT.

Method:  We conducted 45-minute cognitive interviews with 100 adults eligible for AIT across the US. Interviews focused on recalled elements of the allergist-patient decision-making conversation, the extent to which shared decision making was employed, and patient-level barriers/facilitators of AIT use. To facilitate diverse sampling, we recruited adults who: 1) were recommended for AIT but never initiated, 2) started AIT but stopped before reaching maintenance phase, 3) started AIT, but stopped during maintenance phase, and 4) have persisted on AIT.  Data was analyzed using Strauss and Corbin’s Grounded Theory approach.

Result:  This study generated key findings about patients’ decision to initiate AIT, the patient’s experience with therapy over time, and conversations with allergists throughout the treatment process. Through mapping the patients' decision-making process about AIT and commitment to therapy we found that HCPs’ validation of perceived allergy severity, engagement in SDM around eliciting patients’ treatment goals and limitations, and cost discussions were associated with AIT uptake and adherence. Finally, the study found quantifiable patient barriers and facilitators to AIT and persistence on therapy that should be considered in the development of any AIT specific patient decision aid. 

Conclusion:   Our findings indicate that SDM is an approach to care that could help patients and providers discuss evidence about AIT, weigh trade-offs between treatments, tailor the decision to patients’ unique needs and preferences, and help support patients through AIT implementation. AIT patient decision aids can supplement clinical SDM conversations.