Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study

Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived a...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Maria A. Lopez-Olivo [verfasserIn] Gabrielle F. Duhon [verfasserIn] Juan I. Ruiz [verfasserIn] Mehmet Altan [verfasserIn] Hussein Tawbi [verfasserIn] Adi Diab [verfasserIn] Clifton O. Bingham [verfasserIn] Cassandra Calabrese [verfasserIn] Natalia I. Heredia [verfasserIn] Robert J. Volk [verfasserIn] Maria E. Suarez-Almazor [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	qualitative interviews patient education immunotherapy autoimmune diseases

Übergeordnetes Werk:	In: Cancers - MDPI AG, 2010, 15(2023), 10, p 2690
Übergeordnetes Werk:	volume:15 ; year:2023 ; number:10, p 2690

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3390/cancers15102690

Katalog-ID:	DOAJ094406391

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spelling	10.3390/cancers15102690 doi (DE-627)DOAJ094406391 (DE-599)DOAJc9bce1ccb93e4e38af447a2a0ff8965d DE-627 ger DE-627 rakwb eng RC254-282 Maria A. Lopez-Olivo verfasserin aut Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions). qualitative interviews patient education immunotherapy autoimmune diseases Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gabrielle F. Duhon verfasserin aut Juan I. Ruiz verfasserin aut Mehmet Altan verfasserin aut Hussein Tawbi verfasserin aut Adi Diab verfasserin aut Clifton O. Bingham verfasserin aut Cassandra Calabrese verfasserin aut Natalia I. Heredia verfasserin aut Robert J. Volk verfasserin aut Maria E. Suarez-Almazor verfasserin aut In Cancers MDPI AG, 2010 15(2023), 10, p 2690 (DE-627)614095670 (DE-600)2527080-1 20726694 nnns volume:15 year:2023 number:10, p 2690 https://doi.org/10.3390/cancers15102690 kostenfrei https://doaj.org/article/c9bce1ccb93e4e38af447a2a0ff8965d kostenfrei https://www.mdpi.com/2072-6694/15/10/2690 kostenfrei https://doaj.org/toc/2072-6694 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2023 10, p 2690
allfields_unstemmed	10.3390/cancers15102690 doi (DE-627)DOAJ094406391 (DE-599)DOAJc9bce1ccb93e4e38af447a2a0ff8965d DE-627 ger DE-627 rakwb eng RC254-282 Maria A. Lopez-Olivo verfasserin aut Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions). qualitative interviews patient education immunotherapy autoimmune diseases Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gabrielle F. Duhon verfasserin aut Juan I. Ruiz verfasserin aut Mehmet Altan verfasserin aut Hussein Tawbi verfasserin aut Adi Diab verfasserin aut Clifton O. Bingham verfasserin aut Cassandra Calabrese verfasserin aut Natalia I. Heredia verfasserin aut Robert J. Volk verfasserin aut Maria E. Suarez-Almazor verfasserin aut In Cancers MDPI AG, 2010 15(2023), 10, p 2690 (DE-627)614095670 (DE-600)2527080-1 20726694 nnns volume:15 year:2023 number:10, p 2690 https://doi.org/10.3390/cancers15102690 kostenfrei https://doaj.org/article/c9bce1ccb93e4e38af447a2a0ff8965d kostenfrei https://www.mdpi.com/2072-6694/15/10/2690 kostenfrei https://doaj.org/toc/2072-6694 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2023 10, p 2690
allfieldsGer	10.3390/cancers15102690 doi (DE-627)DOAJ094406391 (DE-599)DOAJc9bce1ccb93e4e38af447a2a0ff8965d DE-627 ger DE-627 rakwb eng RC254-282 Maria A. Lopez-Olivo verfasserin aut Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions). qualitative interviews patient education immunotherapy autoimmune diseases Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gabrielle F. Duhon verfasserin aut Juan I. Ruiz verfasserin aut Mehmet Altan verfasserin aut Hussein Tawbi verfasserin aut Adi Diab verfasserin aut Clifton O. Bingham verfasserin aut Cassandra Calabrese verfasserin aut Natalia I. Heredia verfasserin aut Robert J. Volk verfasserin aut Maria E. Suarez-Almazor verfasserin aut In Cancers MDPI AG, 2010 15(2023), 10, p 2690 (DE-627)614095670 (DE-600)2527080-1 20726694 nnns volume:15 year:2023 number:10, p 2690 https://doi.org/10.3390/cancers15102690 kostenfrei https://doaj.org/article/c9bce1ccb93e4e38af447a2a0ff8965d kostenfrei https://www.mdpi.com/2072-6694/15/10/2690 kostenfrei https://doaj.org/toc/2072-6694 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2023 10, p 2690
allfieldsSound	10.3390/cancers15102690 doi (DE-627)DOAJ094406391 (DE-599)DOAJc9bce1ccb93e4e38af447a2a0ff8965d DE-627 ger DE-627 rakwb eng RC254-282 Maria A. Lopez-Olivo verfasserin aut Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions). qualitative interviews patient education immunotherapy autoimmune diseases Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gabrielle F. Duhon verfasserin aut Juan I. Ruiz verfasserin aut Mehmet Altan verfasserin aut Hussein Tawbi verfasserin aut Adi Diab verfasserin aut Clifton O. Bingham verfasserin aut Cassandra Calabrese verfasserin aut Natalia I. Heredia verfasserin aut Robert J. Volk verfasserin aut Maria E. Suarez-Almazor verfasserin aut In Cancers MDPI AG, 2010 15(2023), 10, p 2690 (DE-627)614095670 (DE-600)2527080-1 20726694 nnns volume:15 year:2023 number:10, p 2690 https://doi.org/10.3390/cancers15102690 kostenfrei https://doaj.org/article/c9bce1ccb93e4e38af447a2a0ff8965d kostenfrei https://www.mdpi.com/2072-6694/15/10/2690 kostenfrei https://doaj.org/toc/2072-6694 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2023 10, p 2690
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callnumber-first	R - Medicine
author	Maria A. Lopez-Olivo
spellingShingle	Maria A. Lopez-Olivo misc RC254-282 misc qualitative interviews misc patient education misc immunotherapy misc autoimmune diseases misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study
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topic_title	RC254-282 Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study qualitative interviews patient education immunotherapy autoimmune diseases
topic	misc RC254-282 misc qualitative interviews misc patient education misc immunotherapy misc autoimmune diseases misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc RC254-282 misc qualitative interviews misc patient education misc immunotherapy misc autoimmune diseases misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study
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title_full	Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study
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author_browse	Maria A. Lopez-Olivo Gabrielle F. Duhon Juan I. Ruiz Mehmet Altan Hussein Tawbi Adi Diab Clifton O. Bingham Cassandra Calabrese Natalia I. Heredia Robert J. Volk Maria E. Suarez-Almazor
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title_sort	physician views on the provision of information on immune checkpoint inhibitor therapy to patients with cancer and pre-existing autoimmune disease: a qualitative study
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title_auth	Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study
abstract	Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).
abstractGer	Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).
abstract_unstemmed	Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).
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The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">qualitative interviews</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">patient education</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">immunotherapy</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">autoimmune diseases</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Neoplasms. Tumors. Oncology. 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Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study

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