title: Patients and gastroenterologists' perceptions of treatments for inflammatory bowel diseases: do their perspectives match?
abstract: BACKGROUND
  Perceptions of appropriateness of treatments may differ between gastroenterologists (GIs) and inflammatory bowel disease (IBD) patients. The aim of this study was to explore and compare GIs' and patients' perceptions of risks and benefits of treatments and prioritization of expected outcomes.
  
  
  METHODS
  Four vignette cases were drawn from clinical situations and used in three independent focus groups with GIs (n = 7), ulcerative colitis (UC-p, n = 8) and Crohn's disease patients (CD-p, n = 6). Content analysis was performed based on the conversation transcripts.
  
  
  RESULTS
  UC-p agreed more often with GIs' treatment choices than CD-p. CD-p often considered 5-ASA as a placebo. UC-p saw topical 5-ASA as a temporary solution, neither comfortable nor practical when professionally active. Azathioprine was considered as the treatment for which the risks versus benefits were perceived as the highest. The main risk perceived by patients on anti-TNFs was a potential loss of response. Divergences were observed on 1) stop of treatment: UC-p did not easily concur with stopping a treatment, which differed from GIs' expectation of patients' perceptions; CD-p were more prone to consider stopping treatment than GIs, 2) perception of outcomes: physicians had a focus on long-term objective goals. Patients' expectations were of shorter term and mainly concerned stress management, nutritional advice, and information on the treatments effects.
  
  
  CONCLUSIONS
  Overall, patients and GIs agreed on perceptions of IBD treatments. GIs seemed more concerned about objective and scientific measures of remission whereas patients focused on quality of life and social outcomes when it came to evaluating a therapy.
authors.affiliation: a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland ;
authors.forename: Carla
authors.initials: C
authors.lastname: Vaucher
authors.affiliation: b Division of Gastroenterology & Hepatology , Lausanne University Hospital , Lausanne , Switzerland ;
authors.forename: Michel H
authors.initials: MH
authors.lastname: Maillard
authors.affiliation: b Division of Gastroenterology & Hepatology , Lausanne University Hospital , Lausanne , Switzerland ;|c Division of Gastroenterology & Hepatology , Basel University Hospital , Basel , Switzerland ;
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
authors.affiliation: a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland ;
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: d Clinique La Source-Beaulieu , Crohn and Colitis Center , Lausanne , Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.affiliation: a Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital , Lausanne , Switzerland ;
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001379:Azathioprine / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D000072102:Gastroenterologists; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life; D013557:Switzerland; D055815:Young Adult
chemical_list: D019804:Mesalamine; D001379:Azathioprine
keywords: Appropriateness of care; Crohn’s disease; focus group; inflammatory bowel disease; treatments perception; ulcerative colitis; vignette case study