title: Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.
abstract: The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.
authors.affiliation: University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA.|University of Chicago MacLean Center for Clinical Medical Ethics, Chicago, Illinois, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
authors.affiliation: University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA.|University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Noa
authors.initials: N
authors.lastname: Krugliak Cleveland
mesh_terms: D019468:Disease Management; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic
references.citation: Aliment Pharmacol Ther. 2011 Jan;33(1):23-32
references.pmid: 21083583
references.citation: Rheumatology (Oxford). 2015 Feb;54(2):278-85
references.pmid: 25172936
references.citation: J Crohns Colitis. 2012 Feb;6 Suppl 2:S243-9
references.pmid: 22463931
references.citation: Dig Liver Dis. 2013 Dec;45(12):969-77
references.pmid: 23932331
references.citation: J Gen Intern Med. 2005 Aug;20(8):686-91
references.pmid: 16050875
references.citation: Ann Rheum Dis. 2010 Apr;69(4):631-7
references.pmid: 20215140
references.citation: Gastroenterology. 2015 Jan;148(1):37-51.e1
references.pmid: 25127678
references.citation: Gut. 2012 Mar;61(3):459-65
references.pmid: 22187072
references.citation: Health Serv Res. 2007 Aug;42(4):1443-63
references.pmid: 17610432
references.citation: J Crohns Colitis. 2014 Dec;8(12):1582-97
references.pmid: 25267173
references.citation: Gastroenterol Hepatol (N Y). 2012 Jan;8(1):29-38
references.pmid: 22347830