Table 3.

Select quotes from physician interviews

Interview topic	Select quotes
What was your overall experience with the PSI in this study?	“It just helped to direct consultations, fairly rapidly, to problem areas, and the main observation was, patients who I’ve been seeing for many, many years, actually aren’t necessarily volunteering these things…” “[A]llowed the treating practitioner to understand the effect of the disease state symptomatically on the patient. That went beyond what we could necessarily glean from our typical approaches to seeing patients with psoriasis.”
Were there changes in how patients understood or discussed the severity of their psoriasis?	“Sometimes the patient really doesn’t want to speak about their disease, or the appearance, and when they are feeling depression they can express something…they do not want to say…in their own mind they can do that in writing and they cannot do that in speaking.”
Were there changes in how you perceived the patient’s perception of the severity of their psoriasis?	“There were many times when the PSI outcome seemed very different from what I would expect.” “I have no other way of knowing how severe their symptoms are if they don’t tell me and so it provided a more objective place to start…” “[F]or some patients there…was far greater distress from symptoms than I was anticipating.”
What were some benefits of using the PSI during your discussions with patients?	“[I]t’s nice to have a number to quantify their symptoms.” “[O]n a more, sort of global level, I think was aware that many patients have a lot of distress from their psoriasis.” “We clearly interact, now with the patient, and how the patient felt about their lesions.”
Describe any change in how the patients communicated with you.	“I think that it was really something that will help to improve the conversation and the relation between patient and doctor.” “[W]e often will express itch but I think it was a validation of the fact that the psoriasis symptoms are more than just itch or pain, that it can be stated different ways, and I think they appreciated that…”
How did the patient’s understanding of severity compare to their diagnosis?	“[T]he severity indicated by the questionnaire, the ultimate score that I got back, was in disagreement…with the results of examination…the PSI outcome seemed very different from what I would expect.” “[T]he patients are affected by, sometimes, the particular site, like forearms, or the hands, or the lesion on the neck, where it appears more…found that it was worse from the patient’s point of view.”
Were there any surprises for you in discussing severity with patients?	“I wouldn’t say surprises but the burning symptom was brought up more than I thought.” “Yes, I would say, at least, a third to half of patients that we enrolled I felt somewhat surprised by the discrepancy between what I thought they would have and what they actually had as a score on the PSI. First the total score could be surprising, let’s say I predicted they’d have a 12 and they came back with a 23.” “[I]f the patient might calmly state, yes, I experience itch, you might think, well, they’re not really emphasizing that symptom. But then…they score the itch domain in the PSI, they give it either a 3 or 4.”
Were there any problematic or beneficial trends that you noticed?	“Sometimes not with the bigger lesions, but where the lesions are, and it really affect patients.” “Itching…that came out, the burning sensation…there were more patients talking about that than we expected.”
Did you notice any trends about symptoms that were most upsetting to patients?	“It affects their sleeping at night. It affects their relations with their partners…” “[G]enital involvement psoriasis…” “The burning sensation is something that, it’s not a rare thing, but it’s not that common.” “Anything that shows up on the face is always on their mind.”
Overall, did the PSI represent what patients’ symptoms were like?	“[I]t was proof to me…the eight domains are highly relevant to the physical experience of having psoriasis.”
Were the discussions about the PSI useful?	“I think the net effect was positive, given the time required for the patient to complete the PSI was minimal, and the information gleaned from the results of the PSI was, on balance, very helpful.” “This is a good representation of what the patient is now at the moment we speak.”
How did the PSI enhance patient care, if at all?	“I think that it was an advantage specifically because it doesn’t take me so much longer and I can go deeper in the relation with the patient.” “Yes, because many of the domains of the PSI are not commonly assessed in your average dermatology visit.”
Were there changes to treatment plans based on the information in the PSI?	“For example, patients with low BSA score but…in the questionnaire…had an impact on their quality or life…I would go more aggressive in choosing a treatment.” “It’s very useful to learn about the value of the Psoriasis Symptoms Index in the detecting the need for a change.” “But, what I did find is that I did refine some of the topical measures that I was prescribing…it tended to be site-specific issues for patients…the genital disease…or one highly pruritic patch…” “I do think it has the ability to help drive a conversation to escalate or de-escalate therapy.”
Were there discussions about quality of life prompted by the PSI process itself?	“For introspective patients, patients that do not speak a lot, or don’t like to speak a lot or have very, very low self-esteem the questionnaire just brought up a lot of issues that we could not get from them in other ways.”
Did the discussions about PSI results bring to light any new information?	“[O]ne of my patients had very limited body surface area but her scores were so severe that it kind of surprised me…other people…had a lot of psoriasis but their scores were a little bit lower.”

BSA body surface area, PSI Psoriasis Symptom Inventory