{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:21:51Z","timestamp":1782955311316,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,8]],"date-time":"2018-07-08T00:00:00Z","timestamp":1531008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with multiple actinic keratoses (<jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>s) should be treated with field\u2010directed therapy. Such treatments challenge patients\u2019 adherence due to out\u2010of\u2010pocket costs, length of treatment and severity of local skin reactions (<jats:styled-content style=\"fixed-case\">LSR<\/jats:styled-content>s). Effective physician\u2013patient communication (<jats:styled-content style=\"fixed-case\">PPC<\/jats:styled-content>) may buffer therapy\u2010related distress, thus improving quality of life, treatment satisfaction and adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We evaluated the interplay between <jats:styled-content style=\"fixed-case\">PPC<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> LSR<\/jats:styled-content> intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>s receiving topical field\u2010directed therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25\u00a0cm<jats:sup>2<\/jats:sup> area), Grade I\/<jats:styled-content style=\"fixed-case\">II AK<\/jats:styled-content>s, for whom the attending dermatologist has prescribed treatment with a topical field\u2010directed therapy. We matched self\u2010reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8\u00a0days; T2: 25\u201330\u00a0days)<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most patients were elderly, married, men with poor socio\u2010economic status and multiple lesions of the scalp or face. The majority (<jats:italic>n<\/jats:italic>\u00a0=\u00a0961) had a prescription of ingenol mebutate (<jats:styled-content style=\"fixed-case\">IMB<\/jats:styled-content>) and 175 received either diclofenac 3% in hyaluronic acid (<jats:styled-content style=\"fixed-case\">DHA<\/jats:styled-content>) or imiquimod 5% (<jats:styled-content style=\"fixed-case\">IMQ<\/jats:styled-content>). Clearance rate at 1\u00a0month was 84%. Most patients felt very supported (<jats:italic>n<\/jats:italic>\u00a0=\u00a0819, 73%) and rated dermatologist's explanations very clear (<jats:italic>n<\/jats:italic>\u00a0=\u00a0608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow\u2010up, especially for those on <jats:styled-content style=\"fixed-case\">IMB<\/jats:styled-content> (\u0394<jats:sub>pre\u2010post<\/jats:sub>\u00a0=\u00a0\u22124.00; other: \u0394<jats:sub>pre\u2010post<\/jats:sub>\u00a0=\u00a0\u22120.25; interaction <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Communication clarity was associated with higher treatment satisfaction scores (\u03b2\u00a0=\u00a00.4\u20130.6, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.01) and lower risk of non\u2010adherence among <jats:styled-content style=\"fixed-case\">IMB<\/jats:styled-content> patients (risk difference: 16%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Communication clarity was associated with patient\u2010reported outcomes and adherence beyond <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>\u2010related clinical parameters. Our study questions the current episodic approach to <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> management and provides the rationale to develop chronic care models fostering patients\u2019 engagement and treatment alliance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.15142","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T13:55:25Z","timestamp":1529416525000},"page":"93-107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Physician\u2013patient communication and patient\u2010reported outcomes in the actinic keratosis treatment adherence initiative (<scp>AK<\/scp>\u2010<scp>TRAIN<\/scp>): a multicenter, prospective, real\u2010life study of treatment satisfaction, quality of life and adherence to topical field\u2010directed therapy for the treatment of actinic keratosis in Italy"],"prefix":"10.1111","volume":"33","author":[{"given":"L.","family":"Neri","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences and Community Health University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Peris","sequence":"additional","affiliation":[{"name":"Department of Dermatology Catholic University Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Longo","sequence":"additional","affiliation":[{"name":"Skin Cancer Unit Arcispedale S. Maria Nuova\u2010IRCCS Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Calvieri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Sciences University of Rome \u2018La Sapienza\u2019 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Frascione","sequence":"additional","affiliation":[{"name":"Department of Dermatologic Oncology Regina Elena National Institute for Cancer Treatment and Research Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Parodi","sequence":"additional","affiliation":[{"name":"Division of Dermatology Universit\u00e0 di Genova, DISEM Genova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Eibenschuz","sequence":"additional","affiliation":[{"name":"Department of Dermatologic Oncology Santa Maria and San Gallicano Dermatologic Institute Istituto Fisioterapici 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