PAKT Tool May Be Able to Improve Outcomes for Patients with AK

Expert recommendations and use of a clinical tool called the personalizing actinic keratosis treatment (PAKT) tool might be used to enhance patient-centric management of actinic keratoses (AK) in clinical practice, consider patient priorities and goals to establish realistic treatment outcomes, and progress care outcomes, according to a study in Acta Dermato-Venereologica.

This study was conducted because present guidance on personalizing long-term care for patients with actinic keratosis is limited, especially in terms of tailoring treatment to singular patient priorities and goals and assisting shared decision making between health care providers and patients.

The study authors’ goal was to pinpoint present unmet needs in care using a modified Delphi approach in a panel made up of 12 dermatologists called the Personalizing Actinic Karatosis Treatment panel. They also wanted to create recommendations to assist personalized, long-term management of AK lesions.

“Actinic keratoses are pre-malignant skin lesions that require personalized care, a lack of which may result in poor treatment adherence and suboptimal outcomes,” said the study authors.

First, panelists came up with recommendations by blindly voting on consensus statements. Consensus was defined as equal to or greater than 75% voting “agree” or “strongly agree.”

It was found that rated attributes of treatment options that matter to patients consist of good efficacy, high tolerability, short treatment duration, good convenience, cosmesis, and field-cancerization management. Photodynamic therapy modalities scored highly across the attributes, aligning with the increased patient preference for this treatment method as observed in clinical trials.

Then, statements that met consensus were used to create a clinical tool where the aim was to improve understanding of disease chronicity and the demand for long-term, recurrent treatment cycles. The tool emphasized key decision stages across the patient journey and highlights the panelist’s ratings of treatment options for qualities prioritized by patients.

a doctor is talking to a patient

The study authors emphasized that the clinical tool is not intended to present as a substitute for clinical guidelines or specific treatment recommendation advice, but to optimize the care process in clinical practice.

The tool, created from the panel recommendations, could be used to support a common goal to care between health care providers (HCPs) and patients, which could create better outcomes and higher patient satisfaction.

“The recommendations support the need for HCPs to explore patient well-being and concerns, which can be a core dimension of expert dermatological care and an expectation of HCP–patient interactions,” highlighted the study authors.

Additionally, the tool can be used in settings outside of the clinic, such as educational settings to support HCP and patient education on chronic disease and the need for consistent management to manage progression of the disease, they explained. Future tool developments could home in on use in a patient-centric framework and be tailored for point-of-care HCPs like primary care physicians, to implement effective patient education when patients receive the initial diagnosis.

The panel stressed that this could be reached through the creation of communication points for HCPs to assist in explaining the life-long nature of AK, legion progression to squamous cell carcinoma (SCC), and the need for repeated treatment cycles.

The tool may even impact non-adherence to treatment linked with poor responses and worse disease outcomes.

Given the elevated risk of the progression of AK and SCC in patients at high risk for developing AK and subsequent SCC, the recommendations help back the need for early and recurrent treatment of AK to constrain new lesion development and progression to SCC.

One of the limitations of this study is that the PAKT recommendations are primarily based on the panel’s experiences and reflect HCP views on AK care, which may differ from patient perspectives. Also, even though the PAKT consensus integrates recommendations from an international expert group, it only characterizes the health care systems where the panel has experience and might not account for nuances in other regions like product availability, reimbursement, and the individual cost of treatment(s) for patients.

“Further understanding of how to personalize AK care for different patient groups at high risk (e.g. organ transplant recipients) is still needed, given their increased risk of malignancy and because many conventional AK therapies are often less effective for these patients,” concluded the study authors.

They also said that they look forward to feedback on the clinical tool in practice and insights on possible future uses.

Reference

Morton C, Baharlou S, Basset-Seguin, N, et al. Expert recommendations on facilitating personalized approaches to long-term management of actinic keratosis: the personalizing actinic keratosis treatment (PAKT) project. Acta Derm Venereol. Published online June 8, 2023. Accessed July 21, 2023. doi: 10.2340/actadv.v103.6229