Topic 4: Respond to Risk Concerns and Treatment Fatigue
A patient who declines escalation may be making a considered choice. They may also be responding to a past adverse effect, misinformation, fear of a rare harm, financial uncertainty, or exhaustion from repeated treatment failure. Ask permission to explore the concern before repeating information.
| Communication move | Example |
| Acknowledge | ‘You have already tried several treatments. It makes sense that another change feels exhausting.’ |
| Elicit | ‘What have you heard about this option, and which risk worries you most?’ |
| Clarify | ‘Would it help if I compared that risk with the risks of ongoing uncontrolled inflammation?’ |
| Check | ‘In your own words, what do you see as the main benefit and concern?’ |
| Keep the door open | ‘If you are not ready today, let’s agree on what would prompt us to revisit this.’ |
Greater patient involvement in HS treatment decisions has been associated with greater therapy satisfaction. Association does not establish that involvement alone causes satisfaction, but it supports making the patient’s role explicit rather than assuming it.3