title: Don't Forget the Doctor: Gastroenterologists' Preferences on the Development of mHealth Tools for Inflammatory Bowel Disease.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) encompasses a number of disorders of the gastrointestinal tract. Treatment for IBD is lifelong and complex, and the majority of IBD patients seek information on the Internet. However, research has found existing digital resources to be of questionable quality and that patients find content lacking. Gastroenterologists are frontline sources of information for North American IBD patients, but their opinions and preferences for digital content, design, and utility have not been investigated. The purpose of this study is to systematically explore gastroenterologists' perceptions of, and design preferences for, mHealth tools.
  
  
  OBJECTIVE
  Our goal was to critically assess these issues and elicit expert feedback by seeking consensus with Canadian gastroenterologists.
  
  
  METHODS
  Using a qualitative approach, a closed meeting with 7 gastroenterologists was audio recorded and field notes taken. To synthesize results, an anonymous questionnaire was collected at the end of the session. Participant-led discussion themes included methodological approaches to non-adherence, concordance, patient-centricity, and attributes of digital tools that would be actively supported and promoted.
  
  
  RESULTS
  Survey results indicated that 4 of the 7 gastroenterologists had experienced patients bringing digital resources to a visit, but 5 found digital patient resources to be inaccurate or irrelevant. All participants agreed that digital tools were of increasing importance and could be leveraged to aid in consultations and save time. When asked to assess digital attributes that they would be confident to refer patients to, all seven indicated that the inclusion of evidence-based facts were of greatest importance. Patient peer-support networks were deemed an asset but only if closely monitored by experts. When asked about interventions, nearly all (6/7) preferred tools that addressed a mix of compliance and concordance, and only one supported the development of tools that focused on compliance. Participants confirmed that they would actively refer patients and other physicians to digital resources. However, while a number of digital IBD tools exist, gastroenterologists would be reluctant to endorse them.
  
  
  CONCLUSIONS
  Gastroenterologists appear eager to use digital resources that they believe benefit the physician-patient relationship, but despite the trend of patient-centric tools that focus on concordance (shared decision making and enlightened communication between patients and their health care providers), they would prefer digital tools that highlight compliance (patient following orders). This concordance gap highlights an issue of disparity in digital health: patients may not use tools that physicians promote, and physicians may not endorse tools that patients will use. Further research investigating the concordance gap, and tensions between physician preferences and patient needs, is required.
authors.affiliation: Evolution Health Systems Inc., Toronto, ON, Canada. tvanmierlo@evolutionhs.com.
authors.forename: Trevor
authors.identifier: http://orcid.org/0000-0002-5675-0084
authors.initials: T
authors.lastname: van Mierlo
authors.forename: Rachel
authors.identifier: http://orcid.org/0000-0001-7826-6480
authors.initials: R
authors.lastname: Fournier
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0002-7382-0080
authors.initials: R
authors.lastname: Fedorak
keywords: IBD; adherence; compliance; concordance; gastroenterology; mHealth; shared decision making; therapeutic alliance; ulcerative colitis