Issue 24

Clinical Question

In the era of shared decision-making, do gastroenterologists and patients with IBD have similar objectives and perceptions regarding treatment outcomes and expectations?

Editor’s Bottom Line

Overall, patients and GIs agreed on perceptions of IBD treatments. GIs seemed more concerned about objective and scientific measures of remission whereas patients focused on quality of life and social outcomes when it came to evaluating a therapy.

Editorial Comment

The CDHF developed the BRAT (Benefits, Risks, Assessment Tool) for physicians and patients to address risks and benefits of various medications and their side effects and outcomes. Please see the full BRAT at: https://cdhf.ca/bank/document_en/93explore-the-cdhf-ibd-brat.pdf

Reference

Vaucher C, Maillard MH, Froehlich F, et al. Patients and gastroenterologists’ perceptions of treatments for inflammatory bowel diseases: do their perspectives match? Scand J Gastroenterol. 2016 Sep;51(9):1056–61. https://www.ncbi.nlm.nih.gov/pubmed/26891800

Synopsis

This qualitative exploratory study enrolled participants into one of three focus groups: practicing gastroenterologists caring for patients with IBD, patients with ulcerative colitis (UC), or patients with Crohn’s disease (CD). Each focus group read vignettes describing a common IBD situation including symptoms after which treatment(s) would be prescribed and what outcome(s) were expected. Next, treatment option(s) by experts for the vignettes were provided and the focus groups were asked if they agreed and how would they feel if they were the patient. The interview discussion guides were semi-structured addressing key topics such as risks, benefits, outcomes, and alternatives.

The CD patient (n=6) believed that 5-ASA was ineffective while UC patients (n=8) considered topical 5-ASA as a temporary, inconvenient solution. Both groups believed azathioprine had the highest risk to benefit ratio while the major risk with anti-TNFs was loss of response. Overall, physicians focused on long-term objective outcomes while patients were oriented to the shorter term with emphasis on stress management, nutrition, and treatment effects.

Details

Study Design: Prospective qualitative study
Funding: Swiss National Science Foundation
Allocation: n/a
Setting: Switzerland
Level of Evidence: 2c (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.