Making therapeutic decisions in inflammatory bowel disease: the role of patients.
OBJECTIVE
The treatment of inflammatory bowel disease (IBD) is becoming more complex due to the introduction of new medications and evolving treatment algorithms. Data suggest that more aggressive treatment will yield improved clinical results. Although promising, it is not clear if patients will agree to this new approach. This review aims to describe what we know about patients' perceptions of risks and benefits of treatment, how much risk IBD patients are willing to accept, and to introduce ideas to facilitate better patient communication.


RESULTS
Patients and parents of children with IBD appear to be willing to accept the known risks associated with IBD therapies, but demand substantial treatment benefit to make this tradeoff. As patients with IBD have misperceptions about the risks and benefits of treatment, it is important to develop better methods of communicating medical information.


CONCLUSIONS
There are now more treatment options for patients with IBD. To increase patients' participation in medical decisions, it is critical to fairly present the tradeoffs of risks versus benefits of treatment. Tools are being developed to more clearly present clinical trial data, risks of medication side effects and for calculating individualized risks of disease complications and response to therapy.
Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA. corey.a.siegel@hitchcock.org
Corey A
CA
Siegel
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003082:Colectomy / Q000379:methods; D003657:Decision Making; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D018579:Patient Selection; D010817:Physician-Patient Relations; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents