A Comprehensive Conceptual Model of the Experience of Chronic Itch in Adults

Jonathan I Silverberg*, Robert W. Kantor, Prarthana Dalal, Catherine Hickey, Sara Lynn Shaunfield, Karen Kaiser Tegel, Jin-Shei Lai, David Cella

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Itch is common and often debilitating. Itch is best assessed by self-report, often using patient-reported outcome measures (PROMs). Current PROMs for itch are limited and may not capture its full impact on quality of life (QOL). Objective: We sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid PROMs of itch. Methods: Using mixed methods, including systematic review (n = 491 articles), semi-structured interviews (n = 33 adults with chronic itch with multiple etiologies), and grounded theory using a constant comparative approach, we developed a conceptual model of itch. Results: We found the Wilson and Cleary model to be a reasonable framework for organizing our findings. It includes five primary components: biological and physiological variables, symptom status, functional status, general health perceptions, and QOL. We propose a causal relationship beginning with the biological and physiological driving factors, with direct and indirect impacts of itch and its sequelae, including pain and sleep disturbance. These can impair function, lead to task avoidance, stigma, social life and relationship problems, emotional disturbances, and treatment burden. Together, these sequelae alter one’s perceptions of health, QOL, and treatment response. Conclusions: Our conceptual model demonstrates the profound patient-burden of itch and identifies unmet needs in the evaluation and management of itch.

Original languageEnglish (US)
Pages (from-to)759-769
Number of pages11
JournalAmerican Journal of Clinical Dermatology
Volume19
Issue number5
DOIs
StatePublished - Oct 1 2018

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Quality of Life
Social Stigma
Affective Symptoms
Self Report
Health Status
Sleep
Interviews
Pain
Health
Therapeutics
Patient Reported Outcome Measures
Grounded Theory

ASJC Scopus subject areas

  • Dermatology

Cite this

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title = "A Comprehensive Conceptual Model of the Experience of Chronic Itch in Adults",
abstract = "Background: Itch is common and often debilitating. Itch is best assessed by self-report, often using patient-reported outcome measures (PROMs). Current PROMs for itch are limited and may not capture its full impact on quality of life (QOL). Objective: We sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid PROMs of itch. Methods: Using mixed methods, including systematic review (n = 491 articles), semi-structured interviews (n = 33 adults with chronic itch with multiple etiologies), and grounded theory using a constant comparative approach, we developed a conceptual model of itch. Results: We found the Wilson and Cleary model to be a reasonable framework for organizing our findings. It includes five primary components: biological and physiological variables, symptom status, functional status, general health perceptions, and QOL. We propose a causal relationship beginning with the biological and physiological driving factors, with direct and indirect impacts of itch and its sequelae, including pain and sleep disturbance. These can impair function, lead to task avoidance, stigma, social life and relationship problems, emotional disturbances, and treatment burden. Together, these sequelae alter one’s perceptions of health, QOL, and treatment response. Conclusions: Our conceptual model demonstrates the profound patient-burden of itch and identifies unmet needs in the evaluation and management of itch.",
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A Comprehensive Conceptual Model of the Experience of Chronic Itch in Adults. / Silverberg, Jonathan I; Kantor, Robert W.; Dalal, Prarthana; Hickey, Catherine; Shaunfield, Sara Lynn; Tegel, Karen Kaiser; Lai, Jin-Shei; Cella, David.

In: American Journal of Clinical Dermatology, Vol. 19, No. 5, 01.10.2018, p. 759-769.

Research output: Contribution to journalArticle

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T1 - A Comprehensive Conceptual Model of the Experience of Chronic Itch in Adults

AU - Silverberg, Jonathan I

AU - Kantor, Robert W.

AU - Dalal, Prarthana

AU - Hickey, Catherine

AU - Shaunfield, Sara Lynn

AU - Tegel, Karen Kaiser

AU - Lai, Jin-Shei

AU - Cella, David

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Itch is common and often debilitating. Itch is best assessed by self-report, often using patient-reported outcome measures (PROMs). Current PROMs for itch are limited and may not capture its full impact on quality of life (QOL). Objective: We sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid PROMs of itch. Methods: Using mixed methods, including systematic review (n = 491 articles), semi-structured interviews (n = 33 adults with chronic itch with multiple etiologies), and grounded theory using a constant comparative approach, we developed a conceptual model of itch. Results: We found the Wilson and Cleary model to be a reasonable framework for organizing our findings. It includes five primary components: biological and physiological variables, symptom status, functional status, general health perceptions, and QOL. We propose a causal relationship beginning with the biological and physiological driving factors, with direct and indirect impacts of itch and its sequelae, including pain and sleep disturbance. These can impair function, lead to task avoidance, stigma, social life and relationship problems, emotional disturbances, and treatment burden. Together, these sequelae alter one’s perceptions of health, QOL, and treatment response. Conclusions: Our conceptual model demonstrates the profound patient-burden of itch and identifies unmet needs in the evaluation and management of itch.

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