Defining ‘Freedom from Disease’ in Plaque Psoriasis: Preliminary Outputs Using Delphi Methodology, Involving Nurses, Physicians, and People with Psoriasis - European Medical Journal

Defining ‘Freedom from Disease’ in Plaque Psoriasis: Preliminary Outputs Using Delphi Methodology, Involving Nurses, Physicians, and People with Psoriasis

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EMJ Dermatology 9.1 Feature Image
Anthony Bewley,1 *Elfie Deprez2

This study was sponsored by Janssen. Deprez received consulting fees from Janssen. Bewley received ad hoc honoraria or travel grants from AbbVie, Almirall, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Sanofi, and UCB.


The authors would like to thank all other members of the Delphi consensus panel: Ilse van Ee, Alexander Egeberg, Matthias Augustin, Curdin Conrad, Valeria Corazza, Ludovica Donati, Jo Lambert, Rozalina Lăpădatu, Anette Meyer, Carle Paul, Rebecca Penzer-Hick, Karen Stephen, and Jim van der Zon.


Medical writing and editorial support were provided by Cello Health Communications (Europe), sponsored by Janssen.

EMJ Dermatol. ;9[1]:59-60. Abstract Review No. AR5.
Delphi consensus, health-related quality of life, psoriasis.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Psoriasis is a chronic disease associated with high disease burden, and its impact on well-being and health-related quality of life is often underestimated.1,2 On top of well-known skin symptoms, psoriasis can also affect mental health, daily social activities, and work. Most outcome measures used in psoriasis focus primarily on skin symptoms. Although scales such as the Dermatology Life Quality Index (DLQI) may capture some aspects of psoriasis-related impact on health-related quality of life, they do not capture the full experience of people living with psoriasis, and individuals with psoriasis may have different criteria for judging their treatment success. With the advent of highly effective psoriasis medications, there has been a growing interest in the complete clearance of skin symptoms but less attention to what complete ‘freedom from disease’ means for people with psoriasis.


The ongoing study discussed in this abstract review aims to build a unified consensus on the definition of ‘freedom from disease’ supported by both people with psoriasis and their healthcare providers. This will be achieved using a modified Delphi consensus method involving a consensus panel comprising six people with psoriasis, three nurses, and six dermatologists from different European countries (Figure 1).

Figure 1: Modified Delphi approach to build consensus on the definition of ’freedom from disease’ for people with psoriasis.


The panel performed a literature review and held a planning meeting to identify the main domains involved in freedom from disease, which were established to be ‘management of clinical symptoms’, ‘psychosocial elements’, ‘quality of life and well-being’, ‘treatment’, and ‘healthcare team support’. Following identification of the main domains, subsequent workshops were held to draft lists of statements representing aspects of each domain. These statements were put forward to a voting group comprising 166 respondents (of which 129 were people with psoriasis) who rated each statement according to its importance to them. Aspects of freedom from disease rated as high-priority in this first voting round included being clear of lesions on visible locations and intimate areas, the possibility to live a normal life, quality of life being independent from psoriasis, a desire to have access to and understanding of effective treatments, and a good relationship with healthcare providers.

In the next stage of the consensus process, the panel will assess the results from the initial voting round, revise the statements, and put the revised statements forward to the voting group for a second round of voting. The results from this final voting round will form the basis for the consensus statement.


This Delphi consensus gives people with psoriasis an equal share of voice at every stage of the process, in line with recommendations for people-centred care from the World Health Organization. Once completed, this Delphi process will provide a broad consensus on the meaning of ‘freedom from disease’, a potential new treatment target supported by both people with psoriasis and their healthcare providers.

Bhosle MJ et al. Quality of life in patients with psoriasis. Health Qual Life Outcomes. 2006;4:35. Moon HS et al. Psoriasis and psycho-dermatology. Dermatol Ther (Heidelb). 2013;3(2):117–30.

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