Expert Recommendations on Facilitating Personalized Approaches to Long-term Management of Actinic Keratosis: The Personalizing Actinic Keratosis Treatment (PAKT) Project

Abstract

Actinic keratoses are pre-malignant skin lesions that require personalized care, a lack of which may result in poor treatment adherence and suboptimal outcomes. Current guidance on personalizing care is limited, notably in terms of tailoring treatment to individual patient priorities and goals and supporting shared decision-making between healthcare professionals and patients. The aim of the Personalizing Actinic Keratosis Treatment panel, comprised of 12 dermatologists, was to identify current unmet needs in care and, using a modified Delphi approach, develop recommendations to support personalized, long-term management of actinic keratoses lesions. Panellists generated recommendations by voting on consensus statements. Voting was blinded and consensus was defined as ≥ 75% voting ’agree’ or ’strongly agree’. Statements that reached consensus were used to develop a clinical tool, of which, the goal was to improve understanding of disease chronicity, and the need for long-term, repeated treatment cycles. The tool highlights key decision stages across the patient journey and captures the panellist’s ratings of treatment options for attributes prioritized by patients. The expert recommendations and the clinical tool can be used to facilitate patient-centric management of actinic keratoses in daily practice, encompassing patient priorities and goals to set realistic treatment expectations and improve care outcomes.

SIGNIFICANCE

Actinic keratoses are skin lesions that form due to long-term, repeated exposure to the sun. Lesions can progress to squamous cell carcinoma; hence a key treatment goal is to prevent malignant progression. There is limited guidance on personalizing care for individual patients and supporting shared decision-making between physicians and patients to prevent suboptimal treatment outcomes. To support personalized actinic keratoses care, a group of 12 expert dermatologists used e-surveys to generate recommendations and develop a clinical tool. These can be used to guide shared decision-making between patients and healthcare professionals to support optimal, personalized, long-term care.