Shared decision-making in severe asthma therapy: qualitative study of physician–patient communication

Biologics are indicated for severe asthma, but little is known about the factors driving patient and physician decisions surrounding their use. To understand decision drivers for biologic use and conversational dynamics between patients with severe asthma and physicians. This retrospective database study used anonymized physician-patient conversations (recorded September 2018–August 2020) from routine clinical visits, captured in Verilogue’s physician–patient syndicated database. Eligible conversations included those of patients with severe asthma, who were considering biologic therapy (Topic 1), had initiated biologic within 7 months of clinical visit (Topic 2), or were discontinuing/considering switching biologic treatment (Topic 3). Conversations were analyzed quantitatively and descriptively by topic. Overall, 50 conversations between 14 physicians and 50 patients were included (considering biologic, n = 10; recent biologic initiation, n = 20; switched/discontinued biologic, n = 20). Physicians had 68–73% share of the conversation. When considering biologic treatment, the presence of symptoms (including coughing, wheezing, shortness of breath and chest tightness) drove the decision, with 3/10 patients providing additional symptom impact/severity details, and 2/10 describing adjustments to accommodate symptoms. Physicians set unspecified treatment goals and modest expectations for biologic efficacy, framing any symptom control as success (13/20 conversations). Patient symptom assessment drove the decision to continue, discontinue, or switch biologic treatment: in 5/20 cases, physicians asked patients if they were “better” or the medication is “helping”. This study suggests that patients relied on physicians to shape patient–physician interactions and treatment expectations. This suggests that shared decision-making may improve physicians’ understanding of the impact severe asthma has on patients and facilitate the setting of treatment expectations.