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Bokemeyer B, Plachta-Danielzik S, Steiner IM, Pohlschneider D, Urzica E, Hartmann P, Zemke J, Tappe U, Schreiber S, Steinkat N, Langbrandtner J, Hüppe A, Stargardt T. Inflammatory bowel disease (IBD) patients with impaired quality of life on biologic therapy benefit from the support of an IBD nurse specialist: Results of a randomised controlled trial in Germany (IBD BIO-ASSIST study). Aliment Pharmacol Ther 2024; 59:1082-1095. [PMID: 38429885 DOI: 10.1111/apt.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/16/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND IBDBIO-ASSIST was a randomised controlled trial assessing the efficacy of care provided by IBD nurse specialists in Germany in improving health-related quality of life (QoL) in IBD patients on biologic therapy. AIM To evaluate patient-related outcomes and economic consequences associated with integrating IBD nurses into usual care. METHODS We randomly assigned 1086 patients with IBD on biologic therapy to a control group (CG) receiving usual care or an intervention group (IG) receiving additional care from an IBD nurse specialist. The primary outcome was disease-specific QoL (sIBDQ) assessed at 6, 12 and 18 months. RESULTS At baseline, patients in both groups were highly satisfied with their treatment situation and had relatively high sIBDQ values (range: 1-7; CG: 5.12; IG: 4.92). In the intention-to-treat (ITT) analysis of the overall sample, there was no significant difference in sIBDQ between groups at the assessment time points. However, a per-protocol analysis of patients with impaired QoL at baseline (EQ-VAS < 75 [median]), showed improvement in sIBDQ over 6 months that became significant at month 12 and remained significant through month 18 (baseline: IG 4.24; CG 4.31; 18 months: IG 5.02; CG 4.76; p = 0.017). CONCLUSION High baseline satisfaction of IBD patients with treatment and the relatively high baseline sIBDQ values may have contributed to the lack of significant difference in sIBDQ scores for the overall sample. However, patients with impaired QoL derived significant benefit from additional care provided by an IBD nurse specialist, leading to meaningful improvements in sIBDQ over the long term.
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Affiliation(s)
- Bernd Bokemeyer
- Competence Network IBD, Kiel, Germany
- Interdisciplinary Crohn Colitis Centre, Minden, Germany
- Clinic of General Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sandra Plachta-Danielzik
- Competence Network IBD, Kiel, Germany
- Institute of Human Nutrition and Food Science, Christian-Albrechts University, Kiel, Germany
| | - Isa Maria Steiner
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
| | | | | | | | | | | | - Stefan Schreiber
- Clinic of General Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - Jana Langbrandtner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Centre for Population Medicine and Health Services Research, University of Lübeck, Lübeck, Germany
| | - Angelika Hüppe
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Centre for Population Medicine and Health Services Research, University of Lübeck, Lübeck, Germany
| | - Tom Stargardt
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
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Norouzkhani N, Faramarzi M, Ghodousi Moghadam S, Karimi MA, Shokri Shirvani J, Bahari A, ShojaeiBaghini M, Eslami S, Tabesh H. Identification of the informational and supportive needs of patients diagnosed with inflammatory bowel disease: a scoping review. Front Psychol 2023; 14:1055449. [PMID: 37251032 PMCID: PMC10211349 DOI: 10.3389/fpsyg.2023.1055449] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inflammatory Bowel Disease (IBD) affects the quality of life. Patient education and support needs are crucial components of comprehensive chronic illness care. The main purposes of this review were to (i) explore the informational and supportive needs of these patients to improve the quality of life in the existing literature and (ii) identify the gaps related to the needs of the patients in articles. Methods The scoping review is based on the Daudt methodological framework, a modified version of Arksey and O'Malley. Electronic databases were extensively searched from January 01, 2000 to April 30, 2022. Four electronic databases (PubMed/Medline, CINAHL, APA PsycInfo, Psychology and Behavioral Sciences Collection, APA PsycArticles, and ProQuest) were searched using controlled vocabulary, and specific keywords. The searched terms were matched to each database. We manually searched two key journals, namely the Journal of Inflammatory Bowel Disease and the Journal of Crohn's and Colitis. Results In the review, 75 studies on the assessment of the information and support needs of patients with IBD were reviewed. In this regard, 62 and 53 studies were regarding information needs and support needs, respectively. Most of the information needs of patients with IBD reported in the studies were related to diet needs, and educational needs were the most essential support needs. Conclusions Health policymakers and managers can develop care and educational programs related to this disease in health centers according to the needs of the patients. Health professionals, especially gastroenterologists, are the primary referral sources for information on patients. Therefore, gastroenterologists can take the lead in planning and educating the patients and sharing their decisions. Systematic review registration OSF, https://doi.org/10.17605/OSF.IO/3MWGJ.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahbobeh Faramarzi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Sara Ghodousi Moghadam
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mohammad Amin Karimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie ShojaeiBaghini
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Blunck D, Kastner L, Nissen M, Winkler J. The Effectiveness of Patient Training in Inflammatory Bowel Disease Knowledge via Instagram: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36767. [PMID: 36260385 PMCID: PMC9631171 DOI: 10.2196/36767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients’ knowledge was found to be a key contributor to the success of therapy. Many efforts have been made to educate patients in their disease. However, research found that many patients still lack knowledge regarding their disease. Integrating patient education into social media platforms can bring materials closer to recipients. Objective The aim of this study is to test the effectiveness of patient education via Instagram. Methods A randomized controlled trial was conducted to test the effectiveness of patient education via Instagram among patients with inflammatory bowel disease. Participants were recruited online from the open Instagram page of a patient organization. The intervention group was educated via Instagram for 5 weeks by the research team; the control group did not receive any educational intervention. The knowledge about their disease was measured pre- and postintervention using the Inflammatory Bowel Disease Knowledge questionnaire. Data were analyzed by comparing mean knowledge scores and by regression analysis. The trial was purely web based. Results In total, 49 participants filled out both questionnaires. The intervention group included 25 participants, and the control group included 24 participants. The preintervention knowledge level of the intervention group was reflected as a score of 18.67 out of 24 points; this improved by 3 points to 21.67 postintervention. The postintervention difference between the control and intervention groups was 3.59 points and was statistically significant (t32.88=–4.56, 95% CI 1.98-5.19; P<.001). Results of the regression analysis, accounting for preintervention knowledge and group heterogeneity, indicated an increase of 3.33 points that was explained by the intervention (P<.001). Conclusions Patient education via Instagram is an effective way to increase disease-related knowledge. Future studies are needed to assess the effects in other conditions and to compare different means of patient education. Trial Registration German Clinical Trials Register DRKS00022935; https://tinyurl.com/bed4bzvh
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Affiliation(s)
- Dominik Blunck
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Lena Kastner
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Michael Nissen
- Machine Learning and Data Analytics Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Song K, Wu D. Shared decision-making in the management of patients with inflammatory bowel disease. World J Gastroenterol 2022; 28:3092-3100. [PMID: 36051346 PMCID: PMC9331519 DOI: 10.3748/wjg.v28.i26.3092] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
The rapid progress of research into inflammatory bowel disease (IBD) has resulted in increasingly more treatment options. Different options have different advantages and disadvantages, and the preferences of patients may also differ. If patients can be invited to the formulation of medical decision-making, their compliance and satisfaction would be improved, thus possibly achieving better therapeutic results. The present review aims to summarize the current literature on shared decision-making (SDM) in the management of IBD, with the goal of promoting the application of SDM.
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Affiliation(s)
- Kai Song
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
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Schubert S, Picker N, Cavlar T, Knop J, Kahraman A, Mohl W. Inflammatory Bowel Disease Patients' Treatment Preferences Using a Discrete Choice Experiment Technique: The InPuT Study. Adv Ther 2022; 39:2889-2905. [PMID: 35451740 PMCID: PMC9023727 DOI: 10.1007/s12325-022-02143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/21/2022] [Indexed: 12/07/2022]
Abstract
Introduction The aim of this study was to investigate patients’ preferences regarding the evolving treatment landscape in Crohn’s disease (CD) and ulcerative colitis (UC) based on a discrete choice experiment. Methods Eligible patients (aged 18 years or older) had a confirmed diagnosis of CD or UC and were willing and able to participate in telephone interviews. The survey design is based on a prior literature review, a pilot study, and clinical expert discussions. Preferences related to clinical and practical features of advanced therapies, like tumor necrosis factor alpha inhibitors, anti-integrins, anti-interleukins, and Janus kinase inhibitors, were assessed. Patients were asked to choose between two different hypothetical treatment alternatives visualized in up to 11 choice scenarios. Based on these choices, the relative importance of treatment characteristics was derived from regression coefficients estimated by a conditional logit model. Results Of the 291 patients included, 219 (75%) were eligible for this analysis. Among the evaluated attributes in CD, 1-year remission rate was ranked highest, with 42.3% relevance for the overall decision. The second most important attribute was the frequency of serious adverse events (AE) (25.1%), followed by sustained remission over 2 years (17.8%). Lower importance was assigned to the administration mode (14.6%) and none to the frequency of non-serious AE (0.1%). In UC, preferences were driven by efficacy (25.3% for mucosal healing; 23.4% for corticosteroid-free remission) and the frequency of serious AE (18.3%), followed by the administration mode (18.1%). Also, non-serious AE were classified as relevant factors for decision-making (10.7%), while maintaining remission for at least 2 years showed no significant impact (4.4%). Conclusion For both indications, efficacy outcomes were rated most important, followed by the frequency of serious AE. Variations were mainly found in the evaluation of non-serious AE and sustained remission. Considering patient preferences may improve the effectiveness of available therapies for moderate to severe CD and UC. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02143-z.
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Tamizifar B, Ehsani M, Farzi S, Adibi P, Taleghani F, Farzi S, Shahriari M, Moladoost A. Development of a Patient Decision Aid to Help People Living with Inflammatory Bowel Disease. Middle East J Dig Dis 2022; 14:57-63. [PMID: 36619728 PMCID: PMC9489324 DOI: 10.34172/mejdd.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: Patient decision aid (PDA) is a tool, which helps the improvement of shared decisionmaking and is a part of the paradigm shift from physician-centered decisions to patient-centered shared decision making. In this study, we aimed to describe the process used to develop a PDA for facilitating shared decision-making about treatment in patients with inflammatory bowel disease (IBD) who need medication (corticosteroid, azathioprine, anti-TNF, and infliximab) or surgery. METHODS: The development process of PDA included: 1) The development of a prototype based on literature review and interview 2) 'Alpha' testing with patients and clinicians 3) 'Beta' testing in real conditions and 4) The production of a final version. This process took about 12 months (2019-2020). The participants were adult patients with IBD, gastroenterologists, and nurses. RESULTS: The final PDA contains four important sections: 1) Introduction about IBD disease, the purpose of developing PDA, and emphasis on shared decision-making 2) Benefits and risks of main medicines 3) The success rate as well as the incidence of complications after surgery, and 4) The conclusion about patients' satisfaction with PDA to choose the treatment options. Besides, PDA evaluation in the real world setting showed that 100% of physicians (n=4) and 86% of patients (n=12) were completely satisfied with the content of the PDA and considered it applicable and useful. CONCLUSION: This PDA can help patients participate in the shared decision-making process and select the best medical and surgical treatment methods. The feedback received from clinicians and patients showed their satisfaction with using the PDA.
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Affiliation(s)
- Babak Tamizifar
- Assistant Professor, Department of Internal Medicine, School of Medicine, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Ehsani
- Assistant Professor, Nursing Care Research center, Faculty of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Farzi
- Assistant Professor, Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding Author: Sedigheh Farzi, PhD, Hezar Jerib St, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Postal code: 8174673461 Tel:+98 3137927589 Fax:+98 3136699398
| | - Peyman Adibi
- Professor, Department of Internal Medicine, School of Medicine, Integrative Functional Gastroenterology Research Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Professor, Nursing and Midwifery Care Research Centre, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Farzi
- PhD Candidate of Nursing, Student Research Center, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Shahriari
- Professor, Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Moladoost
- MSc of Nursing, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Hüppe A, Herzog N, Eisemann N, Langbrandtner J, Raspe H. [Assessment of Psychosocial Problems in Inflammatory Bowel Diseases - Who Uses the Online Version at www.CED-aktiv-werden.de?]. Gesundheitswesen 2021; 84:466-473. [PMID: 33761557 DOI: 10.1055/a-1378-8859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY Taking into consideration and addressing patients' psychosocial problems is one of the characteristics of good clinical practice; this applies to IBD-patients as well. Since 2014, such patients have been offered an online questionnaire-based problem assessment linked to care recommendations. The primary aim of our data analysis was to carry out a comparative description of socio-demographic and disease-related characteristics of users of the free service. METHODOLOGY For a retrospective data analysis, the online sample (OG) comprising 2156 CD and UC patients was compared with 852 individuals who participated in 2 IBD health services research studies (CG). Besides descriptive statistics, regression and covariance analyses were carried out. RESULTS The OG differed from CG in a highly significant and partly clinically relevant way. One in 3 of the OG was younger than 30 years of age (CG: 19%); 45% had completed high school (CG: 36%). In the OG, fewer were in disease remission (OG 34%; CG 59%). Even controlling for these differences, the OG reported more often greater burden in 12 of 17 psychosocial problem areas and expressed a greater need for information on 5 of 9 disease-related topic areas. CONCLUSION The internet-based assessment of psychosocial problems is used primarily by younger, better educated, and physically as well as psychosocially more burdened IBD patients with comparatively high information needs. The assessment may help them to actively participate in their care. Our data sheds further light on the peculiarities of internet-based study groups.
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Affiliation(s)
- Angelika Hüppe
- Institut für Sozialmedizin und Epidemiologie,Universität zu Lübeck, Lübeck, Deutschland
| | - Nina Herzog
- Produktmanagement,EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Deutschland
| | - Nora Eisemann
- Institut für Sozialmedizin und Epidemiologie,Universität zu Lübeck, Lübeck, Deutschland
| | - Jana Langbrandtner
- Institut für Sozialmedizin und Epidemiologie,Universität zu Lübeck, Lübeck, Deutschland
| | - Heiner Raspe
- Institut für Ethik, Geschichte und Theorie der Medizin, University of Munster, Münster, Deutschland
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Berding A, Witte C, Gottschald M, Kaltz B, Weiland R, Gerlich C, Reusch A, Kruis W, Faller H. Beneficial Effects of Education on Emotional Distress, Self-Management, and Coping in Patients with Inflammatory Bowel Disease: A Prospective Randomized Controlled Study. Inflamm Intest Dis 2017; 1:182-190. [PMID: 29922675 DOI: 10.1159/000452989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) suffer from various physical as well as psychological impairments, and patient education may help improve their well-being. Therefore, we developed a manualized education program for IBD patients addressing medical and psychological issues. This study aimed to evaluate it in a large controlled trial. METHODS A total of 181 IBD outpatients participated in a prospective, randomized, waitlist-controlled trial; assessments were made before as well as 2 weeks and 3 months after intervention. Analysis of covariance was used to assess intervention effects on disease-related worries and concerns (primary outcome), fear of progression, coping with anxiety, health competencies, health-related quality of life (HRQoL), perceived disease activity, symptoms of depression and anxiety, disease-related knowledge, and coping strategies. Participants' satisfaction with the program was also evaluated. RESULTS At 2 weeks and 3 months after intervention, we found significant large effects of our education program on skill and technique acquisition, knowledge, and coping with IBD. Moreover, we found significant medium effects on disease-related worries and concerns, fear of progression, coping with anxiety, constructive attitudes and approaches, as well as coping with disease-related negative emotions. The number of coping strategies used was significantly higher at 3 months. We did not find any effects on perceived disease activity, HRQoL, positive and active engagement in life, or symptoms of anxiety and depression. The program was rated very favorably by the attendees. CONCLUSION Our education program contributed to improvements in psychological distress, self-management skills, and coping and was appreciated by its attendees.
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Affiliation(s)
- Anja Berding
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany.,Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christine Witte
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | | | - Birgit Kaltz
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | - Romy Weiland
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christian Gerlich
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Andrea Reusch
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Wolfgang Kruis
- Department of Internal Medicine, Protestant Hospital Kalk, Cologne, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Lofland JH, Johnson PT, Ingham MP, Rosemas SC, White JC, Ellis L. Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs. Patient Prefer Adherence 2017; 11:947-958. [PMID: 28572722 PMCID: PMC5441672 DOI: 10.2147/ppa.s133222] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM), a process whereby physicians and patients collaborate to select interventions, is not well understood for biologic treatment of autoimmune conditions. METHODS This was a cross-sectional survey of adults initiating treatment for Crohn's disease or ulcerative colitis (inflammatory bowel disease, IBD) or psoriatic arthritis or rheumatoid arthritis (RA/PA). Survey data were linked to administrative claims for 6 months before (baseline) and after (follow-up) therapy initiation. Measures included the Shared Decision Making Questionnaire, Patient Activation Measure (PAM), Morisky Medication Adherence Scale (MMAS), general health, and treatment satisfaction. Claims-based Quan-Charlson comorbidity scores, persistence, medication possession ratio (MPR), and health care costs were examined. Patients were compared by participation (SDM) and nonparticipation (non-SDM) in SDM. RESULTS Among 453 respondents, 357 were eligible, and 306 patients (204 RA/PA and 102 IBD) were included in all analyses. Overall (n=357), SDM participants (n=120) were more often females (75.0% vs 62.5%, P=0.018), had lower health status (48.0 vs 55.4, P=0.005), and higher Quan-Charlson scores (1.0 vs 0.7, P=0.035) than non-SDM (n=237) participants. Lower MMAS scores (SDM 0.17 vs non-SDM 0.41; P<0.05) indicated greater likelihood of adherence; SDM participants also reported higher satisfaction with medication and had greater activation (PAM: SDM vs non-SDM: 66.9 vs 61.6; P<0.001). Mean MPR did not differ, but persistence was longer among SDM participants (111.2 days vs 102.2 days for non-SDM; P=0.029). Costs did not differ by SDM status overall, or among patients with RA/PA. The patients with IBD, however, experienced lower (P=0.003) total costs ($9,404 for SDM vs $25,071 for non-SDM) during follow-up. CONCLUSION This study showed greater likelihood of adherence and satisfaction for patients who engaged in SDM and reduced health care costs among patients with IBD who engaged in SDM. This study provides a basis for defining SDM participation and detecting differences by SDM participation for biologic treatment selection for autoimmune conditions.
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Affiliation(s)
- Jennifer H Lofland
- Janssen Global Commercial Strategic Organization – Immunology, Raritan, NJ
| | - Phaedra T Johnson
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
- Correspondence: Phaedra T Johnson, Health Economics and Outcomes Research, Optum Inc., 11000 Optum Circle, Eden Prairie, MN 55344, USA, Tel +1 952 205 7737, Email
| | - Mike P Ingham
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Sarah C Rosemas
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
| | - John C White
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
| | - Lorie Ellis
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
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Cha JM, Park DI, Park SH, Shin JE, Kim WS, Yang SK. Physicians Should Provide Shared Decision-Making for Anti-TNF Therapy to Inflammatory Bowel Disease Patients. J Korean Med Sci 2017; 32:85-94. [PMID: 27914136 PMCID: PMC5143303 DOI: 10.3346/jkms.2017.32.1.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/09/2016] [Indexed: 01/27/2023] Open
Abstract
Shared decision-making may increase the effectiveness of inflammatory bowel disease (IBD) treatment, as different anti-tumor necrosis factor (anti-TNF) administrations may have different effects on the quality of life (QOL). Patient preference is integral to the selection of anti-TNFs and their routes of administration, however, previous studies on the patient preference to anti-TNFs are inconsistent and limited. We evaluated the predictive factors for preferences to anti-TNF administrations in IBD patients between March and August in 2015. Consecutive adult IBD patients who received care at one of four university hospitals in Korea were invited to participate in this study. Patients were administered questionnaires about their preferences regarding anti-TNF therapy and QOL. During the study period, 322 IBD patients completed the questionnaires. IBD patients preferred intravenous anti-TNFs to subcutaneous anti-TNFs (2.4:1), and 58.4% of patients preferred shared decision-making. When comparing subcutaneous anti-TNF therapy with intravenous anti-TNF therapy, patients with higher income levels, patients who experienced adverse events with prior medication and patients with a longer disease duration preferred subcutaneous anti-TNF therapy over intravenous anti-TNF therapy (P = 0.043, P = 0.000, and P = 0.029, respectively). In a logistic regression analysis, high income level (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.1-3.5; P = 0.026) and an adverse event with prior medication (OR 4.0; 95% CI 2.2-7.2; P = 0.000) and were found to be independent predictors for preference to subcutaneous anti-TNF therapy. Therefore, physicians should share decision-making with their IBD patients regarding the mode of anti-TNF administration.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University School of Medicine, Cheonan, Korea
| | - Wan Soo Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Reusch A, Weiland R, Gerlich C, Dreger K, Derra C, Mainos D, Tuschhoff T, Berding A, Witte C, Kaltz B, Faller H. Self-management education for rehabilitation inpatients suffering from inflammatory bowel disease: a cluster-randomized controlled trial. Health Educ Res 2016; 31:782-791. [PMID: 27651394 DOI: 10.1093/her/cyw042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months.The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.
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Affiliation(s)
- A Reusch
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - R Weiland
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - C Gerlich
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - K Dreger
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - C Derra
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - D Mainos
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - T Tuschhoff
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - A Berding
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - C Witte
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - B Kaltz
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - H Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
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Pittet V, Vaucher C, Maillard MH, Girardin M, de Saussure P, Burnand B, Rogler G, Michetti P. Information Needs and Concerns of Patients with Inflammatory Bowel Disease: What Can We Learn from Participants in a Bilingual Clinical Cohort? PLoS One 2016; 11:e0150620. [PMID: 26939069 PMCID: PMC4777374 DOI: 10.1371/journal.pone.0150620] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/17/2016] [Indexed: 12/16/2022] Open
Abstract
Background Inflammatory Bowel Disease (IBD) patients are confronted with needs and concerns related to their disease. Aim To explore information expectations of patients included in a national bilingual IBD cohort in Switzerland (SIBDC). Methods This is a mixed-methods study, comprising 1) a semi-narrative survey sent to 1506 patients from the SIBDC and 2) two focus groups conducted with 14 patients to explore and assess the relevance of the survey’s findings. Data collected within the framework of the SIBDC was used to characterize survey’s responders. Results 728 patients (48%) replied to the survey: 52.5% females, 56% Crohn’s disease (CD), 87% secondary/tertiary level educated, 70% full/part-time employed. On average, 47% of patients sought for information, regardless of the disease stage; 27% of them were dissatisfied with information received at the time of first symptoms. During flares, 43% were concerned about drugs and therapies; in remission, 57% had concerns on research and developments; 27% searched for information linked to daily disease management. Information-seeking increased when active disease, for CD with high levels of perceived stress (OR = 2.47; p = 0.003), and for all with higher posttraumatic stress symptoms. The focus groups confirmed a perceived lack of information about general functioning, disease course, treatments and their risks, extra-intestinal symptoms and manifestations. Conclusions Information remains insufficient for IBD patients. Lack of information in specific domains can potentially cause stress and hinder detection of symptoms. Better information should be considered as a potentially important component in improving patients’ outcomes in IBD.
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Affiliation(s)
- Valérie Pittet
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Carla Vaucher
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Michel H. Maillard
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Girardin
- Division of Gastroenterology & Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Philippe de Saussure
- Division of Gastroenterology & Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Bernard Burnand
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology & Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pierre Michetti
- Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland
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Pieper D, Jülich F, Antoine SL, Bächle C, Chernyak N, Genz J, Eikermann M, Icks A. Studies analysing the need for health-related information in Germany - a systematic review. BMC Health Serv Res 2015; 15:407. [PMID: 26399759 PMCID: PMC4579794 DOI: 10.1186/s12913-015-1076-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exploring health-related information needs is necessary to better tailor information. However, there is a lack of systematic knowledge on how and in which groups information needs has been assessed, and which information needs have been identified. We aimed to assess the methodology of studies used to assess information needs, as well as the topics and extent of health-related information needs and associated factors in Germany. METHODS A systematic search was performed in Medline, Embase, Psycinfo, and all databases of the Cochrane Library. All studies investigating health-related information needs in patients, relatives, and the general population in Germany that were published between 2000 and 2012 in German or English were included. Descriptive content analysis was based on predefined categories. RESULTS We identified 19 studies. Most studies addressed cancer or rheumatic disease. Methods used were highly heterogeneous. Apart from common topics such as treatment, diagnosis, prevention and health promotion, etiology and prognosis, high interest ratings were also found in more specific topics such as complementary and alternative medicine or nutrition. Information needs were notable in all surveyed patient groups, relatives, and samples of the general population. Younger age, shorter duration of illness, poorer health status and higher anxiety and depression scores appeared to be associated with higher information needs. CONCLUSION Knowledge about information needs is still scarce. Assuming the importance of comprehensive information to enable people to participate in health-related decisions, further systematic research is required.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Fabian Jülich
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
| | - Sunya-Lee Antoine
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- , Auf'm Hennekamp 65, D-40225, Düsseldorf, Germany.
| | - Nadja Chernyak
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
| | - Jutta Genz
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- , Auf'm Hennekamp 65, D-40225, Düsseldorf, Germany.
| | - Michaela Eikermann
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, D- 51109, Cologne, Germany.
| | - Andrea Icks
- Institute for Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine University, Leibniz-Center for Diabetes Research, Düsseldorf, Germany.
- Public Health Unit, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
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Hueppe A, Langbrandtner J, Raspe H. Inviting patients with inflammatory bowel disease to active involvement in their own care: a randomized controlled trial. Inflamm Bowel Dis 2014; 20:1057-69. [PMID: 24788217 DOI: 10.1097/MIB.0000000000000044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Inflammatory bowel diseases impose on patients a broad spectrum of somatic and psychosocial burden. We hypothesized that patients' self-responsibility in planning and initiating adequate usually multimodal health care can be supported by self-assessment and proactive information, thus improving health-related quality of life and social participation. METHODS We conducted a randomized controlled trial among a random sample of adult members of a German statutory health insurance with Crohn's disease or ulcerative colitis with at least 1 inflammatory bowel diseases-related hospital stay or sick leave in 2009 or 2010. Five hundred fourteen patients completed a postal screening questionnaire inquiring about 22 problems. The intervention group (IG) received an automated data analysis with individualized written advice on appropriate health services, and the control group received usual care. Main outcomes were health-related quality of life and social participation. Secondary outcomes included health care utilization, number of screened problems, and self-management skills. RESULTS After 12 months, small beneficial effects were seen for all primary outcomes in the IG: EuroQol visual analog scale score (difference between IG and control group: 4.4; 95% confidence interval, 7.7-1.0; P = 0.011), index for measuring participation restriction (IMET) score (difference between IG and control group: 0.4; 95% confidence interval, 0.07-0.62; P = 0.013). The number of disability days improved only in the IG. The IG reported significantly fewer outpatient visits, fewer disease-related problems, and improved self-management skills (health education impact questionnaire scores) with no increase in disease activity, hospital stays, or consultations with allied health professionals. CONCLUSIONS Our activation and information procedure is effective and beneficial. Further studies might show its usefulness in comprehensive management of patients with inflammatory bowel diseases.
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Bewtra M, Johnson FR. Assessing patient preferences for treatment options and process of care in inflammatory bowel disease: a critical review of quantitative data. Patient 2014; 6:241-55. [PMID: 24127239 DOI: 10.1007/s40271-013-0031-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), consisting of both Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the intestinal tract. As there is no cure for either CD or UC, patients with these conditions face numerous treatment decisions regarding their disease. The aim of this review is to evaluate literature regarding quantitative studies of patient preferences in therapy for IBD with a focus on the emerging technique of stated preference and its application in IBD. Numerous simple survey-based studies have been performed evaluating IBD patients' preferences for medication frequency, mode of delivery, potential adverse events, etc., as well as variations in these preferences. These studies are limited, however, as they are purely descriptive in nature with limited quantitative information on the relative value of treatment alternatives. Time trade-off and standard-gamble studies have also been utilized to quantify patient utility for various treatment options or outcomes. However, these types of studies suffer from inaccurate assumptions regarding patient choice behavior. Stated preference is an emerging robust methodology increasingly utilized in health care that can determine the relative utility for a therapy option as well as its specific attributes (such as efficacy or adverse side effects). Stated preference techniques have begun to be applied in IBD and offer an innovative way of examining the numerous therapy options these patients and their providers face.
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Affiliation(s)
- Meenakshi Bewtra
- Department of Gastroenterology, University of Pennsylvania, 423 Guardian Drive, 724 Blockley Hall, Philadelphia, PA, 19104-6021, USA,
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