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Information and support
Evidence review A
NICE Guideline, No. 198
National Guideline Alliance (UK).
Information and support
Review question
What information and support is valued by people with acne vulgaris, and their parents or carers?
Introduction
The onset of acne at any age can be distressing, particularly facial acne, which may significantly impact people’s appearance and have negative effects on people’s self-esteem and confidence. People who experience acne vulgaris may not initially seek help from their GP and might try to manage the condition, seeking information from many different sources including word of mouth, the internet and local pharmacies. For those experiencing acne vulgaris at the onset of puberty, reliance on parents and caregivers for information and help to manage the condition is likely. People who experience acne in later life may naturally look at different information sources than teenagers. This guideline will take into account the different preferences for information whilst seeking to establish what information and advice is most valued by people living with acne vulgaris.
Summary of the protocol
Please see Table 1 for a summary of the Population, phenomenon of Interest, and Context (PICo) characteristics of this review.
Table 1
Summary of the protocol.
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document (supplementary document 1).
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Clinical evidence
Included studies
A systematic review of the clinical literature was conducted but no studies were identified which were applicable to this review question.
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of clinical studies included in the evidence review
No studies were identified that were applicable to this review question (and so there are no evidence tables in Appendix D). No meta-analysis was undertaken for this review (and so there are no forest plots in Appendix E).
Quality assessment of clinical outcomes included in the evidence review
No studies were identified which were applicable to this review question.
Economic evidence
Included studies
A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in appendix B and economic study selection flow chart in appendix G.
Excluded studies
No economic studies were reviewed at full text and excluded from this review.
Economic model
No economic modelling was conducted for this review question, because the committee agreed that other topics were higher priorities for economic evaluation.
Evidence statements
No evidence was identified which was applicable to this review question.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
The committee were aware of the type of information and support people with acne, their parents or carers may find helpful, such as: adherence tools/tips; antibiotics and their side-effects; commonly-used treatments (for example isotretinoin) and associate risks (for example effect on mood); cosmetics; diet and acne; format of information (for example pamphlet, website); identification, cause and prognosis of acne; lifestyle, sexuality and psychosocial issues; myths and wrongly held beliefs about acne; self-care and skin care routine; skin changes/disfigurement to face/body; what is acne?
The committee noted that these topics may not be present in the literature or different topics may arise that could be considered. However, there was no evidence identified for any of these outcomes or other relevant topics.
The quality of the evidence
No evidence was identified which was applicable to this review question.
Benefits and harms
No evidence was found on what information and support is valued by people with acne vulgaris, and their parents or carers. Therefore, the committee made recommendations based on their knowledge and experience. Despite the lack of evidence, the committee made a strong recommendation to provide information because information provision is an essential part of good clinical practice to help discuss treatment options during the process of shared decision-making.
The committee listed some topics that, based on their experience, they thought most people with acne vulgaris would like to know about. These include possible reasons for acne vulgaris, how it would be treated, the potential impact of acne (for example that it may cause psychological distress); whether there are drawbacks (such as how often to apply treatment and whether it may cause skin irritation) and whether the condition would return and what to do if it does.
Based on experience the committee also noted that it is important to encourage people to adhere to treatment because improvement may not be seen immediately. The committee acknowledged that general information about adherence is covered in the NICE guideline on medicines adherence to which they cross-referred.
The committee were aware that general principles about tailoring information to people’s needs and circumstance are set out in the NICE guideline on patient experience in adult NHS services and decided that this would also be relevant to young people.
The committee discussed support needs of people. They noted that some people may need support by parents or carers during discussions, for example, when the person with acne has a cognitive impairment that makes it difficult to understand information or follow instructions.
Due to the lack of evidence and the positive impact that information provision can have on people’s satisfaction with services and their feelings of being in control of their options, the committee decided to prioritise this topic for a research recommendation (see appendix L).
Other factors the committee took into account
The committee discussed equality considerations in relation to the understanding of treatment plans and regimes for people with cognitive impairments. They noted that it was important that throughout the guideline it is made clear that ‘people with acne’ would be understood to include family and carers where appropriate so that they can also receive information and instruction so that the person can be supported.
Cost effectiveness and resource use
No economic evidence was identified for this review question. The recommendations made by the committee may have very small healthcare resource implications comprising potentially extra healthcare professionals’ time to provide information and support. In current healthcare practice, some information and support is already provided to people with acne. The recommendations are expected to improve the care and quality of life of people with acne and their families and carers, and therefore any resource implications are outweighed by benefits.
Recommendations supported by this evidence review
This evidence review supports recommendations 1.1.1 and 1.1.2 as well as a research recommendation on information and support in the guideline.
References
There were no studies identified that were applicable to this review question.
Appendices
Appendix A. Review protocol
Appendix B. Literature search strategies
Appendix C. Clinical evidence study selection
Appendix D. Evidence tables
Evidence tables for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No evidence was identified which was applicable to this review question.
Appendix E. Forest plots
Forest plots for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No evidence was identified which was applicable to this review question.
Appendix F. GRADE tables
GRADE tables for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No evidence was identified which was applicable to this review question.
Appendix G. Economic evidence study selection
Appendix H. Economic evidence tables
Economic evidence tables for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No economic evidence was identified which was applicable to this review question.
Appendix I. Economic evidence profiles
Economic evidence profiles for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No economic evidence was identified which was applicable to this review question.
Appendix J. Economic analysis
Economic analysis for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded clinical and economic studies for review question: What information and support is valued by people with acne vulgaris, and their parents or carers?
Clinical studies
Table 3. Excluded studies and reasons for their exclusion (PDF, 152K)
Economic studies
No economic evidence was identified for this review.
Appendix L. Research recommendations
Final
Methods, evidence and recommendations
Evidence review underpinning recommendations 1.1.1 and 1.1.2 as well as a research recommendation in the NICE guideline
These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
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