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Shared decision making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options
  1. Corey A Siegel
  1. Correspondence to Dr Corey A Siegel, Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA; corey.a.siegel{at}hitchcock.org

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.

  • Crohn's
  • ulcerative colitis
  • shared decision making
  • patient preferences

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Footnotes

  • Dartmouth-Hitchcock Medical Center and Cedars-Sinai Medical Center have a US patent pending on intellectual property related to the Crohn's disease Risk Prediction Outcome Tool, filed on March 24, 2010, as Docket No. 076/0008. Inventors are CA Siegel, LS Siegel and MC Dubinsky.

  • Funding CAS is supported by a Crohn's and Colitis Foundation of America career development award and by grant number K23DK078678 from the National Institute of Diabetes, Digestive and Kidney Diseases. CAS serves as a consultant to Abbott Laboratories, Centocor, Elan, Prometheus Labs and UCB.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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