Impact of shared decision‐making in onychomycosis treatment: A cross‐sectional study based on the Illuminating Dialogues and Insights in Onychomycosis Management (IDIOM) survey

Onychomycosis is a fungal infection of the nail characterized by deformity and discoloration. Besides aesthetic concerns, it can impair patients' quality of life and increase the risk of secondary bacterial infections as well as the spread of fungal infections to other body sites and other individuals, making it a potential public health concern. Treatment options include oral and topical medications, the latter often requiring long-term therapy. While oral antifungal agents demonstrate high efficacy against onychomycosis, concerns about side effects and drug-drug interactions may act as barriers to their selection. Shared decision-making (SDM) is a collaborative process in which patients and physicians share information based on scientific evidence and make decisions together taking into account the patient's values and preferences. While SDM has been reported to be beneficial across various disease areas, its utility in the treatment of onychomycosis remains insufficiently explored. In this study, we conducted an online survey of patients with onychomycosis to cross-sectionally compare the level of SDM implementation with patient concerns about oral medications, treatment satisfaction, perceived treatment efficacy, and treatment-switching behaviors. The percentage of patients with strong concerns about the side effects and drug-drug interactions of oral medications was significantly lower in the high SDM implementation group (21.7% and 13.0%, respectively) than in the low SDM implementation group (46.1% and 39.5%, respectively). Furthermore, the high SDM implementation group reported significantly higher treatment satisfaction than that reported by the low SDM implementation group, regardless of whether oral or topical treatment was used. These findings underscore the importance of SDM in the treatment of onychomycosis and suggest that dermatologists should actively consider implementing SDM.