Shared decision making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options

Abstract

The treatment of inflammatory bowel disease is becoming more complicated with new medications and new treatment paradigms. Although data are accumulating that the earlier use of immunomodulators and anti-tumor necrosis factor agents are more effective than the standard "step-up" pyramidal treatment algorithm, patients may not be comfortable with this more intensive therapeutic approach. The process of shared decision making engages patients in treatment decisions to optimize the chance that a chosen therapy matches their personal preferences for care. Decision aids are standard shared decision making tools, which are used to present evidence-based data in a patient-friendly manner to help patients with preference-sensitive decisions. Not all care decisions are preference-sensitive, and not all patients are interested in being part of a shared medical decision. The responsibility of the provider is to identify how much of a role patients want, and then determine which decisions need their input to provide the best patient-centered care. The overall goal is to involve patients in decisions so that they are educated about their options, confident in the plan, adherent to chosen therapy and ultimately have a better quality of life.

Preventive health measures in inflammatory bowel disease

“…Thus, the label “IBD” should not discourage PCPs from providing preventive health services to IBD patients. Evidence suggests that building therapeutic physician-patient relationships and shared decision-making is crucial to the outcome of chronic illnesses and IBD[181,182]. Therefore, individual preference is likely to play a role in where and with whom patients choose to receive preventive health.…”

Patient Preferences for Surgical Versus Medical Therapy for Ulcerative Colitis

“…Shared decision making and informed consent have increasing importance in the changing treatment algorithms for IBD. 39 Most of the gastrointestinal providers will escalate medical therapy for their patients with UC due to failure of mesalamine to ensure a durable remission. 40,41 However, our survey indicated that approximately 50% of patients with UC had never discussed surgical options for their UC with either a medical or surgical physician, including 39% of patients with current or previous immunosuppressant therapy use (data not shown).…”

Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease

“…87 In IBD, the selection of antiTNF therapy is an example of a highly preference-sensitive decision. 88 We have learned that IBD patients' perceptions of risk are extremely variable as they relate to antiTNF medications, 65 and patients' willingness to accept risk tends to increase with illness severity. 69,89 However, we have yet to examine how health literacy impacts treatment decisions and perception of risk.…”

“…96 Currently, the impact of a novel Crohn's Disease Shared Decision Making Program is being evaluated in clinical trials. 88,97,98 Thus far, however, only a handful of studies have evaluated decision aids from a health literacy perspective. 86,96 Although data is limited, the use of selected decision support tools in low literacy populations has been shown to increase knowledge, [99][100][101] increase ability to indicate a test preference, 102 and reduce decisional conflict.…”