{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:17:05Z","timestamp":1778717825507,"version":"3.51.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T00:00:00Z","timestamp":1586736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T00:00:00Z","timestamp":1586736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008349","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100008349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Systemic sclerosis (SSc) is a rare, potentially life-threatening condition. The prognosis is difficult to predict, and treatment is complex. This can be difficult to understand or explain, posing challenges for effective physician-patient communication. Our study assessed communication between physicians and patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) to identify information gaps and needs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twenty-three 20-min consultations between physicians (rheumatologists, pulmonologists) and patients (19 real, 4 actors) with diagnosed SSc-ILD across 6 countries were observed and recorded. Interactional sociolinguistic discourse analysis was used to understand the pattern and meaning of communication, whether the needs of both participants were met, and the level of understanding between participants.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In most consultations, patients were given little opportunity to explain their concerns or ask questions. Physicians used plain language but would revert to medical terminology for complex issues. Patients would also use medical terminology, despite not fully understanding the terms, which led to some physicians mistakenly believing that patients had a better understanding than they did. Differences in cognitive models between physicians and patients were often responsible for misunderstandings. However, during effective consultations, patients were invited to tell their story, and physicians used techniques to check and demonstrate understanding, express empathy and build rapport.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Communication challenges between physicians and patients limit joint understanding of SSc-ILD and may result in both parties misunderstanding important information and patients being less aware of self-help management approaches. Strategies should be developed with physicians to facilitate effective communication and increase patient understanding and support.<\/jats:p>\n                <jats:p><jats:table-wrap><jats:table><jats:tbody>\n                      <jats:tr>\n                        <jats:td colspan=\"2\"><jats:bold>Key Points<\/jats:bold><jats:italic>\u2022 Physicians and patients have different explanatory models for SSc-ILD.<\/jats:italic><jats:italic>\u2022 The differences between the physician-constructed\u00a0model of SSc-ILD and the personal model patients construct often result in misunderstandings. <\/jats:italic><jats:italic>\u2022 Many patients with SSc have learned the medical terminology for their condition, but their often limited\u00a0understanding may lead to missed opportunities for physicians\u00a0to provide clear explanations and correct misperceptions.<\/jats:italic><jats:italic>\u2022 The style of consultation determines the information patients share and the degree to which they feel supported by, and confident in, their physicians\u2019 care. <\/jats:italic><\/jats:td>\n                      <\/jats:tr>\n                    <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10067-020-05063-x","type":"journal-article","created":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T12:03:30Z","timestamp":1586779410000},"page":"2989-2998","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Challenges in physician-patient communication for optimal management of systemic sclerosis-associated interstitial lung disease: a discourse analysis"],"prefix":"10.1007","volume":"39","author":[{"given":"Christopher P.","family":"Denton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bee","family":"Laird","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lizette","family":"Moros","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Luis Luna","family":"Flores","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,4,13]]},"reference":[{"issue":"3","key":"5063_CR1","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1007\/s12016-017-8636-1","volume":"55","author":"M Cossu","year":"2018","unstructured":"Cossu M, Beretta L, Mosterman P, de Hair MJH, Radstake TRDJ (2018) Unmet needs in systemic sclerosis understanding and treatment: the knowledge gaps from a scientist\u2019s, clinician\u2019s, and patient\u2019s perspective. Clin Rev Allergy Immunol 55(3):312\u2013331. https:\/\/doi.org\/10.1007\/s12016-017-8636-1","journal-title":"Clin Rev Allergy Immunol"},{"issue":"6","key":"5063_CR2","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1002\/art.38390","volume":"66","author":"SI Nihtyanova","year":"2014","unstructured":"Nihtyanova SI, Schreiber BE, Ong VH, Rosenberg D, Moinzadeh P, Coghlan JG, Wells AU, Denton CP (2014) Prediction of pulmonary complications and long-term survival in systemic sclerosis. Arthritis Rheumatol 66(6):1625\u20131635. https:\/\/doi.org\/10.1002\/art.38390","journal-title":"Arthritis Rheumatol"},{"issue":"4","key":"5063_CR3","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1093\/rheumatology\/keq310","volume":"50","author":"M Bassel","year":"2010","unstructured":"Bassel M, Hudson M, Taillefer SS, Schieir O, Baron M, Thombs BD (2010) Frequency and impact of symptoms experienced by patients with systemic sclerosis: results from a Canadian National Survey. Rheumatology. 50(4):762\u2013767. https:\/\/doi.org\/10.1093\/rheumatology\/keq310","journal-title":"Rheumatology."},{"issue":"10","key":"5063_CR4","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1136\/ard.2009.114264","volume":"69","author":"AJ Tyndall","year":"2010","unstructured":"Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE et al (2010) Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis 69(10):1809\u20131815. https:\/\/doi.org\/10.1136\/ard.2009.114264","journal-title":"Ann Rheum Dis"},{"issue":"11","key":"5063_CR5","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1002\/acr.23207","volume":"69","author":"D Sumpton","year":"2017","unstructured":"Sumpton D, Thakkar V, O'Neill S, Singh-Grewal D, Craig JC, Tong A (2017) \u201cIt\u2019s not me, it's not really me.\u201d Insights from patients on living with systemic sclerosis: an interview study. Arthritis Care Res(Hoboken) 69(11):1733\u20131742. https:\/\/doi.org\/10.1002\/acr.23207","journal-title":"Arthritis Care Res(Hoboken)"},{"issue":"6","key":"5063_CR6","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1177\/1474515114547648","volume":"14","author":"K Currie","year":"2014","unstructured":"Currie K, Strachan PH, Spaling M, Harkness K, Barber D, Clark AM (2014) The importance of interactions between patients and healthcare professionals for heart failure self-care: a systematic review of qualitative research into patient perspectives. Eur J Cardiovasc Nurs 14(6):525\u2013535. https:\/\/doi.org\/10.1177\/1474515114547648","journal-title":"Eur J Cardiovasc Nurs"},{"key":"5063_CR7","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12877-015-0124-y","volume":"15","author":"K Klindtworth","year":"2015","unstructured":"Klindtworth K, Oster P, Hager K, Krause O, Bleidorn J, Schneider N (2015) Living with and dying from advanced heart failure: understanding the needs of older patients at the end of life. BMC Geriatrics 15:125. https:\/\/doi.org\/10.1186\/s12877-015-0124-y","journal-title":"BMC Geriatrics"},{"issue":"1","key":"5063_CR8","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.pec.2009.08.003","volume":"79","author":"H Mead","year":"2010","unstructured":"Mead H, Andres E, Ramos C, Siegel B, Regenstein M (2010) Barriers to effective self-management in cardiac patients: the patient\u2019s experience. Patient Educ Couns 79(1):69\u201376. https:\/\/doi.org\/10.1016\/j.pec.2009.08.003","journal-title":"Patient Educ Couns"},{"issue":"4","key":"5063_CR9","doi-asserted-by":"publisher","first-page":"e60721-e","DOI":"10.1371\/journal.pone.0060721","volume":"8","author":"E Pietrolongo","year":"2013","unstructured":"Pietrolongo E, Giordano A, Kleinefeld M, Confalonieri P, Lugaresi A, Tortorella C et al (2013) Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments. PloS One 8(4):e60721-e. https:\/\/doi.org\/10.1371\/journal.pone.0060721","journal-title":"PloS One"},{"issue":"2","key":"5063_CR10","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1177\/0269216316647610","volume":"31","author":"SN Etkind","year":"2017","unstructured":"Etkind SN, Bristowe K, Bailey K, Selman LE, Murtagh FE (2017) How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data. Palliat Med 31(2):171\u2013180. https:\/\/doi.org\/10.1177\/0269216316647610","journal-title":"Palliat Med"},{"key":"5063_CR11","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.2147\/PPA.S83850","volume":"9","author":"I Baudendistel","year":"2015","unstructured":"Baudendistel I, Noest S, Peters-Klimm F, Herzberg H, Scherer M, Blozik E, Joos S (2015) Bridging the gap between patient needs and quality indicators: a qualitative study with chronic heart failure patients. Patient Prefer Adherence 9:1397\u20131405. https:\/\/doi.org\/10.2147\/PPA.S83850","journal-title":"Patient Prefer Adherence"},{"issue":"12","key":"5063_CR12","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1016\/j.ijnurstu.2012.05.010","volume":"49","author":"AM Clark","year":"2012","unstructured":"Clark AM, Savard LA, Spaling MA, Heath S, Duncan AS, Spiers JA (2012) Understanding help-seeking decisions in people with heart failure: a qualitative systematic review. Int J Nurs Stud 49(12):1582\u20131597. https:\/\/doi.org\/10.1016\/j.ijnurstu.2012.05.010","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"5063_CR13","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12891-017-1603-4","volume":"18","author":"L Mouthon","year":"2017","unstructured":"Mouthon L, Alami S, Boisard A-S, Chaigne B, Hachulla E, Poiraudeau S (2017) Patients\u2019 views and needs about systemic sclerosis and its management: a qualitative interview study. BMC Musculoskelet Disord 18(1):230. https:\/\/doi.org\/10.1186\/s12891-017-1603-4","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"5063_CR14","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2174\/1573398X11666150619182624","volume":"11","author":"S Mittoo","year":"2015","unstructured":"Mittoo S, Frankel S, LeSage D, Strand V, Shah AA, Christopher-Stine L, Danoff S, Hummers LK, Swigris JJ, Huscher D, Christensen AM, Cenac SL, Erbil JK, Ferguson S, Garcia-Valladares I, Grewal HK, Orbai AM, Smith KC, Tran M, Bingham CO 3rd, Castelino FV, Fischer A, Saketkoo LA (2015) Patient perspectives in OMERACT provide an anchor for future metric development and improved approaches to healthcare delivery in connective tissue disease related interstitial lung disease (CTD-ILD). Curr Respir Med Rev 11(2):175\u2013183. https:\/\/doi.org\/10.2174\/1573398X11666150619182624","journal-title":"Curr Respir Med Rev"},{"issue":"9","key":"5063_CR15","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/acm.0000000000000388","volume":"89","author":"BC O\u2019Brien","year":"2014","unstructured":"O\u2019Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA (2014) Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 89(9):1245\u20131251. https:\/\/doi.org\/10.1097\/acm.0000000000000388","journal-title":"Acad Med"},{"key":"5063_CR16","doi-asserted-by":"publisher","DOI":"10.1525\/9780520340848","volume-title":"Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry","author":"A Kleinman","year":"1980","unstructured":"Kleinman A (1980) Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. University of California Press, Berkeley"},{"issue":"3","key":"5063_CR17","doi-asserted-by":"publisher","first-page":"e0152419","DOI":"10.1371\/journal.pone.0152419","volume":"11","author":"ST Gumuchian","year":"2016","unstructured":"Gumuchian ST, Pel\u00e1ez S, Delisle VC, Carrier M-E, Jewett LR, El-Baalbaki G et al (2016) Exploring sources of emotional distress among people living with scleroderma: a focus group study. PloS One 11(3):e0152419. https:\/\/doi.org\/10.1371\/journal.pone.0152419","journal-title":"PloS One"},{"issue":"13","key":"5063_CR18","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1001\/archinte.168.13.1387","volume":"168","author":"LB Mauksch","year":"2008","unstructured":"Mauksch LB, Dugdale DC, Dodson S, Epstein R (2008) Relationship, communication, and efficiency in the medical encounter: creating a clinical model from a literature review. JAMA Intern Med 168(13):1387\u20131395. https:\/\/doi.org\/10.1001\/archinte.168.13.1387","journal-title":"JAMA Intern Med"},{"issue":"3","key":"5063_CR19","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.pec.2006.09.011","volume":"65","author":"LC Zandbelt","year":"2007","unstructured":"Zandbelt LC, Smets EMA, Oort FJ, Godfried MH, de Haes HCJM (2007) Patient participation in the medical specialist encounter: does physicians\u2019 patient-centred communication matter? Patient Educ Couns. 65(3):396\u2013406. https:\/\/doi.org\/10.1016\/j.pec.2006.09.011","journal-title":"Patient Educ Couns."},{"issue":"1","key":"5063_CR20","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12875-016-0537-5","volume":"17","author":"M Fry","year":"2016","unstructured":"Fry M, McLachlan S, Purdy S, Sanders T, Kadam UT, Chew-Graham CA (2016) The implications of living with heart failure; the impact on everyday life, family support, co-morbidities and access to healthcare: a secondary qualitative analysis. BMC Fam Pract 17(1):139. https:\/\/doi.org\/10.1186\/s12875-016-0537-5","journal-title":"BMC Fam Pract"},{"issue":"2","key":"5063_CR21","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jpainsymman.2007.09.012","volume":"36","author":"R Harding","year":"2008","unstructured":"Harding R, Selman L, Beynon T, Hodson F, Coady E, Read C et al (2008) Meeting the communication and information needs of chronic heart failure patients. J Pain Symptom Manag 36(2):149\u2013156. https:\/\/doi.org\/10.1016\/j.jpainsymman.2007.09.012","journal-title":"J Pain Symptom Manag"},{"issue":"11","key":"5063_CR22","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1016\/j.amjcard.2016.03.003","volume":"117","author":"AM Kelemen","year":"2016","unstructured":"Kelemen AM, Ruiz G, Groninger H (2016) Choosing words wisely in communication with patients with heart failure and families. Am J Cardiol 117(11):1779\u20131782. https:\/\/doi.org\/10.1016\/j.amjcard.2016.03.003","journal-title":"Am J Cardiol"},{"issue":"1","key":"5063_CR23","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1377\/hlthaff.28.1.179","volume":"28","author":"J Sochalski","year":"2009","unstructured":"Sochalski J, Jaarsma T, Krumholz HM, Laramee A, McMurray JJV, Naylor MD, Rich MW, Riegel B, Stewart S (2009) What works in chronic care management: the case of heart failure. Health Aff 28(1):179\u2013189. https:\/\/doi.org\/10.1377\/hlthaff.28.1.179","journal-title":"Health Aff"},{"issue":"3","key":"5063_CR24","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.pec.2008.11.015","volume":"74","author":"RL Street","year":"2009","unstructured":"Street RL, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician\u2013patient communication to health outcomes. Patient Educ Couns. 74(3):295\u2013301. https:\/\/doi.org\/10.1016\/j.pec.2008.11.015","journal-title":"Patient Educ Couns."},{"issue":"3","key":"5063_CR25","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0738-3991(02)00194-5","volume":"51","author":"S Michie","year":"2003","unstructured":"Michie S, Miles J, Weinman J (2003) Patient-centredness in chronic illness: what is it and does it matter? Patient Educ Couns. 51(3):197\u2013206. https:\/\/doi.org\/10.1016\/S0738-3991(02)00194-5","journal-title":"Patient Educ Couns."},{"issue":"5","key":"5063_CR26","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1016\/j.pec.2015.11.019","volume":"99","author":"J Nicolai","year":"2016","unstructured":"Nicolai J, Buchholz A, Seefried N, Reuter K, H\u00e4rter M, Eich W et al (2016) When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians\u2019 communication styles and the match of decision-making styles on decision regret. Patient Educ Couns. 99(5):739\u2013746. https:\/\/doi.org\/10.1016\/j.pec.2015.11.019","journal-title":"Patient Educ Couns."},{"key":"5063_CR27","doi-asserted-by":"publisher","first-page":"33","DOI":"10.2147\/PPA.S115090","volume":"11","author":"M Tintor\u00e9","year":"2016","unstructured":"Tintor\u00e9 M, Alexander M, Costello K, Duddy M, Jones DE, Law N, O'Neill G, Uccelli A, Weissert R, Wray S (2016) The state of multiple sclerosis: current insight into the patient\/health care provider relationship, treatment challenges, and satisfaction. Patient Prefer Adherence 11:33\u201345. https:\/\/doi.org\/10.2147\/PPA.S115090","journal-title":"Patient Prefer Adherence"},{"issue":"7","key":"5063_CR28","doi-asserted-by":"publisher","first-page":"e0158982","DOI":"10.1371\/journal.pone.0158982","volume":"11","author":"L Dennison","year":"2016","unstructured":"Dennison L, McCloy Smith E, Bradbury K, Galea I (2016) How do people with multiple sclerosis experience prognostic uncertainty and prognosis communication? A qualitative study. PloS One 11(7):e0158982. https:\/\/doi.org\/10.1371\/journal.pone.0158982","journal-title":"PloS One"},{"issue":"8","key":"5063_CR29","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1177\/1359105314562084","volume":"21","author":"A Senders","year":"2016","unstructured":"Senders A, Sando K, Wahbeh H, Peterson Hiller A, Shinto L (2016) Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs. J Health Psychol 21(8):1676\u20131687. https:\/\/doi.org\/10.1177\/1359105314562084","journal-title":"J Health Psychol"},{"issue":"4","key":"5063_CR30","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/j.1369-7625.2009.00555.x","volume":"12","author":"S Koch-Weser","year":"2009","unstructured":"Koch-Weser S, Dejong W, Rudd RE (2009) Medical word use in clinical encounters. Health Expect 12(4):371\u2013382. https:\/\/doi.org\/10.1111\/j.1369-7625.2009.00555.x","journal-title":"Health Expect"},{"issue":"3","key":"5063_CR31","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s11897-014-0203-y","volume":"11","author":"E Lambrinou","year":"2014","unstructured":"Lambrinou E, Protopapas A, Kalogirou F (2014) Educational challenges to the health care professional in heart failure care. Curr Heart Fail Rep 11(3):299\u2013306. https:\/\/doi.org\/10.1007\/s11897-014-0203-y","journal-title":"Curr Heart Fail Rep"},{"issue":"7","key":"5063_CR32","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.3899\/jrheum.151309","volume":"43","author":"A Nakayama","year":"2016","unstructured":"Nakayama A, Tunnicliffe DJ, Thakkar V, Singh-Grewal D, O\u2019Neill S, Craig JC et al (2016) Patients\u2019 perspectives and experiences living with systemic sclerosis: a systematic review and thematic synthesis of qualitative studies. J Rheumatol. 43(7):1363. https:\/\/doi.org\/10.3899\/jrheum.151309","journal-title":"J Rheumatol."}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-020-05063-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10067-020-05063-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-020-05063-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:10:13Z","timestamp":1618272613000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10067-020-05063-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,13]]},"references-count":32,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["5063"],"URL":"https:\/\/doi.org\/10.1007\/s10067-020-05063-x","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"value":"0770-3198","type":"print"},{"value":"1434-9949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,13]]},"assertion":[{"value":"20 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 March 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"C Denton reports grants and personal fees from GSK, personal fees from Boehringer Ingelheim, grants and personal fees from Inventiva, personal fees from Actelion, grants and personal fees from CSL Behring, personal fees from Bayer, personal fees from Roche, personal fees from Sanofi, during the conduct of the study. L Moros, and JL Luna Flores are employees of Boehringer Ingelheim. B Laird was a contractor to Boehringer Ingelheim at the time this research was conducted.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The procedures followed in this study were in accordance with the Declaration of Helsinki. All participants provided written informed consent before taking part in the study, and all study data were held according to European Union (EU) data protection laws. The research outline was discussed with the Reading Independent Ethics Committee (UK), who advised that no ethics committee review was required. Additionally, and per the European Pharmaceutical Market Research Association (EphMRA) Code of Conduct 2019, this research was classified as market research and therefore does not require ethics committee approval (includes Brazil, Canada, Denmark, Finland, France, Germany, Greece, Italy, Japan, Mexico, the\u00a0Netherlands, Norway, Poland, Russia, South Korea, Spain, Sweden, Turkey, the UK and the USA).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}