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

Gut. 2012 Mar;61(3):459-65. doi: 10.1136/gutjnl-2011-300988. Epub 2011 Dec 20.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Biological Products / therapeutic use
  • Decision Making*
  • Decision Support Techniques
  • Humans
  • Inflammatory Bowel Diseases / drug therapy*
  • Patient Education as Topic / methods
  • Patient Participation*
  • Patient Preference
  • Physician-Patient Relations
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Biological Products
  • Tumor Necrosis Factor-alpha