title: What do changes in inflammatory bowel disease management mean for our patients?
abstract: Treatment goals in Crohn's disease are evolving beyond the control of symptoms. A treat-to-target approach to management that features earlier initiation of TNF antagonist therapy will enable resolution of objective parameters of inflammation. The decision to initiate anti-TNF therapy should be based on a patient-specific assessment of risks and benefits. This paradigm necessitates a complex process, influenced by multiple factors that include the quality of data available, physicians' and patients' knowledge of the data, and the preferences and values of patients, physicians and society. The potential 'opportunity cost' resulting from a delay in initiation of effective therapy, a consideration that has been neglected in the past, must also enter into the equation. Our evolving approach to the management of Crohn's disease challenges patients to participate in the decision-making process and to become an active partner in their care. Ideally, this evolution should occur within the context of an enduring physician/patient relationship that is based on mutual trust. Motivational communication provides a useful technique to improve dialogue and collaboration between healthcare professionals and patients, and may help to engage and motivate patients to commit to managing their disease.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada. subrata.ghosh@albertahealthservices.ca
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Geert
authors.initials: G
authors.lastname: D'Haens
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.forename: Eva M
authors.initials: EM
authors.lastname: Szigethy
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000523:psychology; D009042:Motivation; D010347:Patient Care Planning; D010358:Patient Participation; D010817:Physician-Patient Relations; D018570:Risk Assessment; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha