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      Inflammatory bowel disease patient profiles are related to specific information needs: A nationwide survey

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          Abstract

          BACKGROUND

          Inflammatory bowel diseases (IBD) is a heterogenous, lifelong disease, with an unpredictable and potentially progressive course, that may impose negative psychosocial impact on patients. While informed patients with chronic illness have improved adherence and outcomes, previous research showed that the majority of IBD patients receive insufficient information regarding their disease. The large heterogeneity of IBD and the wide range of information topics makes a one-size fits all knowledge resource overwhelming and cumbersome. We hypothesized that different patient profiles may have different and specific information needs, the identification of which will allow building personalized computer-based information resources in the future.

          AIM

          To evaluate the scope of disease-related knowledge among IBD patients and determine whether different patient profiles drive unique information needs.

          METHODS

          We conducted a nationwide survey addressing hospital-based IBD clinics. A Total of 571 patients completed a 28-item questionnaire, rating the amount of information received at time of diagnosis and the importance of information, as perceived by participants, for a newly diagnosed patient, and for the participants themselves, at current time. We performed an exploratory factor analysis of the crude responses aiming to create a number of representative knowledge domains (factors), and analyzed the responses of a set of 15 real-life patient profiles generated by the study team.

          RESULTS

          Participants gave low ratings for the amount of information received at disease onset (averaging 0.9/5) and high ratings for importance, both for the newly diagnosed patients (mean 4.2/5) and for the participants themselves at current time (mean 3.5/5). Factor analysis grouped responses into six information-domains. The responses of selected profiles, compared with the rest of the participants, yielded significant associations (defined as a difference in rating of > 0.5 points with a P < 0.05). Patients with active disease showed a higher interest in work-disability, stress-coping, and therapy-complications. Patients newly diagnosed at age > 50, and patients with long-standing disease (> 10 years) showed less interest in work-disability. Patients in remission with mesalamine or no therapy showed less interest in all domains except for nutrition and long-term complications.

          CONCLUSION

          We demonstrate unmet patient information needs. Analysis of various patient profiles revealed associations with specific information topics, paving the way for building patient-tailored information resources.

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          Most cited references21

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          Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations.

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            The Manitoba IBD Index: evidence for a new and simple indicator of IBD activity.

            A single-item indicator of disease activity over an extended period of time, the Manitoba Inflammatory Bowel Disease Index (MIBDI), is introduced and compared against several standard measures for assessing activity in patients with Crohn's disease (CD) and ulcerative colitis (UC). Participants enrolled in the Manitoba IBD Cohort Study, a population-based longitudinal cohort study (N=353), were assessed semiannually by survey, clinical interview, and blood sample during a 2-year period. The MIBDI is based on patient self-reports of symptom persistence for the previous 6 months, using a 6-level response format. The MIBDI had good sensitivity compared with the Harvey-Bradshaw Index (HB; 0.88), Powell-Tuck Index (PT; 0.84), and Inflammatory Bowel Disease Questionnaire (IBDQ; 0.89), which was maintained at two subsequent annual measurements. Test-retest reliability was also strong (Spearman's r=0.81). Discriminant function analyses identified common discriminating variables of active disease for CD and UC that included HB, PT, and IBDQ subscales of bowel and systemic symptoms, prolonged symptom severity (e.g., abdominal and joint pain, tiredness, diarrhea), and recent persistent pain related to IBD. Unique discriminators included weight problems (CD) and blood in stool (UC). A single-item, patient-defined disease activity measure, the MIBDI, showed a high degree of sensitivity for classifying individuals with regard to disease status over time compared with the existing disease activity measures, and strong convergent validity with expected proxy measures of disease. These relationships remained consistent over time. Thus, the MIBDI shows promise as a valid, brief tool for measuring disease activity over an extended period.
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              Shared decision making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options.

              The treatment of inflammatory bowel disease is becoming more complicated with new medications and new treatment paradigms. Although data are accumulating that the earlier use of immunomodulators and anti-tumor necrosis factor agents are more effective than the standard "step-up" pyramidal treatment algorithm, patients may not be comfortable with this more intensive therapeutic approach. The process of shared decision making engages patients in treatment decisions to optimize the chance that a chosen therapy matches their personal preferences for care. Decision aids are standard shared decision making tools, which are used to present evidence-based data in a patient-friendly manner to help patients with preference-sensitive decisions. Not all care decisions are preference-sensitive, and not all patients are interested in being part of a shared medical decision. The responsibility of the provider is to identify how much of a role patients want, and then determine which decisions need their input to provide the best patient-centered care. The overall goal is to involve patients in decisions so that they are educated about their options, confident in the plan, adherent to chosen therapy and ultimately have a better quality of life.
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                Author and article information

                Contributors
                Journal
                World J Gastroenterol
                World J. Gastroenterol
                WJG
                World Journal of Gastroenterology
                Baishideng Publishing Group Inc
                1007-9327
                2219-2840
                14 August 2019
                14 August 2019
                : 25
                : 30
                : 4246-4260
                Affiliations
                Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. saleh@ 123456hadassah.org.il
                Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
                Department of Gastroenterology, Galilee Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Nahariya 22100, Israel
                Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
                IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB R3E3P4, Canada
                Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
                Research Branch, IDF Medical Corps, Tel-Hashomer, Ramat Gan 52630, Israel
                Institute of Gastroenterology, Meir Medical Center, Kfar-saba 4428164, Israel
                Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
                Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
                Institute of Gastroenterology, Sheba Medical Center, Ramat-Gan 52630, Israel
                Institute of Gastroenterology, Rabin Medical Center, Petach-Tikva 49100, Israel
                IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB R3E3P4, Canada
                Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
                Author notes

                Author contributions: Daher S, Khoury T, Benson A, Bernstein CN and Israeli E formulated study concept and design; Daher S, Benson A, Naftali T, Eliakim R, Ben-Bassat O and Israeli E contributed to acquisition of data; all authors contributed to analysis, interpretation of data and critical revision of the manuscript for important intellectual content; Daher S, Khoury T, Benson A, Hammerman O and Israeli E contributed to drafting of the manuscript; Kedem R assisted with statistical analysis; Israeli E supervised the performance of all stages of the study; all authors approved the final version of the manuscript; Prof John R Walker deceased December 14, 2018.

                Corresponding author: Saleh Daher, MA, MD, Attending Doctor, Attending Physician, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, P.O.B 12000, Jerusalem 91120, Israel. saleh@ 123456hadassah.org.il

                Telephone: +972-2-6778417

                Article
                jWJG.v25.i30.pg4246
                10.3748/wjg.v25.i30.4246
                6700696
                649cfa34-8610-4d8c-a42c-5bc61f2ab962
                ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 18 March 2019
                : 9 June 2019
                : 22 June 2019
                Categories
                Observational Study

                inflammatory bowel diseases,information needs,patient education,knowledge resources,patient profiles

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