title: Patient and clinician preferences for surgical and medical treatment options in ulcerative colitis.
abstract: OBJECTIVE
  When treating patients with refractory ulcerative colitis (UC), the choice between escalating medical management or surgery can be difficult. The aim of this study was to quantify the preferences of patients and clinicians for the treatment options in UC.
  
  
  METHODS
  Ulcerative colitis outpatients were interviewed to measure their preferences for five scenarios examining the management of acute and chronic UC, using a prospective measure of preference method that generates two utility scores: willingness and amount of expected life to trade or gamble. A self-administered questionnaire was mailed to Australian and New Zealand colorectal surgeons and gastroenterologists.
  
  
  RESULTS
  Fifty-five patients (26 medical and 29 surgical), 91 surgeons and 78 gastroenterologists were surveyed. In the acute setting, 89% of patients, 69% of gastroenterologists and 55% of surgeons were willing to trade part of their life expectancy to avoid a permanent stoma, while for chronic disease 71% of patients were prepared to trade to avoid an operation with a permanent stoma compared with 55% for an operation with a pouch (P = 0.01). Both patients and gastroenterologists were more prepared to gamble or trade to avoid any surgery than were colorectal surgeons. All groups were aligned in their decision to undergo yearly colonoscopy surveillance rather than to undergo definitive surgery that would result in a stoma.
  
  
  CONCLUSIONS
  Patient preferences for the treatment of UC were more aligned to those of gastroenterologists than those of colorectal surgeons. Despite postoperative studies revealing an equal quality of life for pouch and stoma patients, this study confirmed that a pouch is the preferred surgical option.
authors.affiliation: Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Byrne
authors.forename: K-K
authors.initials: KK
authors.lastname: Tan
authors.forename: J M
authors.initials: JM
authors.lastname: Young
authors.forename: W
authors.initials: W
authors.lastname: Selby
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000628:therapy*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D003107:Colorectal Surgery; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D005260:Female; D005762:Gastroenterology; D006801:Humans; D007081:Ileostomy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents
keywords: Preferences; decision-making; surgery; ulcerative colitis