Patient preferences between surgical and medical treatment in Crohn's disease.
OBJECTIVE
Crohn's disease poses difficult choices in which the most appropriate treatment option is not always obvious. When this state of uncertainty exists, patients' preferences should have an increasingly important part of clinical decision making. The purpose of this study was to compare patients' preferences for surgical intervention in Crohn's disease with the preferences of surgeons and gastroenterologists.


METHODS
Outpatients with Crohn's disease were interviewed to quantify their preferences for six scenarios by using the prospective preference measure. An identical questionnaire was mailed to all Australian and New Zealand colorectal surgeons and a random sample of 300 Australian gastroenterologists.


RESULTS
Forty-one of 123 patients with Crohn's disease (33 percent), 92 of 127 colorectal surgeons (72 percent), and 74 of 272 gastroenterologists (27 percent) participated. There were significant differences between patients and gastroenterologists for three of six scenarios and between surgeons and gastroenterologists in four of six scenarios. Seventy-six percent of gastroenterologists were willing to gamble to avoid an ileocolic resection compared with 37 percent of surgeons (chi-squared = 25.44; P < 0.0001) and 39 percent of patients (chi-squared = 15.44; P < 0.001).


CONCLUSIONS
Patients and clinicians were able to trade and gamble life expectancy as a measure of preference for varying hypothetical surgical treatments, even though these treatment options impacted on quality of life rather than survival. Patients' preferences did not align with clinicians. For most scenarios, colorectal surgeons' preferences were significantly different to those of gastroenterologists.
Byrne
Christopher M
CM
Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service & University of Sydney, P.O. Box M157, Missenden Road, NSW, 2050, Sydney, Australia.
Solomon
Michael J
MJ
Young
Jane M
JM
Selby
Warwick
W
Harrison
James D
JD
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000601:surgery* / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008511:Medicine; D009520:New Zealand; D017060:Patient Satisfaction; D011446:Prospective Studies; D013038:Specialization; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires