“Adherence” til topikal behandling av psoriasis: Betydningen av oppstartsamtale med sykepleier forut for lysterapi. En kombinert design studie som inkluderer pasienter med moderat til alvorlig plakkpsoriasis.

Abstract

Background: Psoriasis is a chronic, immune-mediated skin disease. The treatment goal is to control the severity of the skin symptoms and prevent comorbidities to occur. The patient’s own contributions are fundamental. However, several studies show nonadherence to topical treatment. Purpose: Nurse counselling was offered to patients before initiating UVtreatment. The study examined the relationship between nurse counselling, the adherence to topical treatment, and if it could contribute to an increase in the efficacy of UV-therapy. Material and methods: This is a mixed method design study, and included 29 patients (n=29). They were randomized into two independent groups. PASI and DLQI were scored at baseline, after 12-15 UV-exposures and during the final week of UV-therapy. Data were analyzed using SPSS. Eight semi-structured interviews were conducted, and categorized and analyzed. Results: The Mann-Whitney U test showed no statistically significant difference on psoriasis severity or quality of life between the two groups. The patients reported these topics: 1.The wish to conceal psoriasis from others. 2. The treatment must be efficient. 3. The patient’s knowledge needs to be taken into account. 4. The benefit of nurse counselling. Conclusions: The nurse counselling had no statistically significant effect on PASI or DLQI, yet the study showed that patients who had participated in nurse counselling had higher adherence to topical treatment than the control group. When values like empathy, autonomy and maintenance of the patient’s values and preferences are taken into account, a motivation process is initiated. This in turn can contribute to higher adherence to topical treatment. Relevance: Many patients with chronic diseases like psoriasis have poor adherence to longterm treatment. Several interventions can contribute to increased adherence, and it is important to study interventions that aim to support adherence to treatment and better health behaviour. Nurse counselling is offered to patients prior to UV-therapy, and it is of importance to study how this intervention could contribute to improve adherence to topical treatment and thereby optimize the treatment result.