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P297. What do healthcare professionals know about fatigue in patients with IBD and how do they manage it?

W. Czuber-Dochan1, C. Norton1, S. Berliner2, F. Bredin3, M. Darvell4, A. Forbes5, M. Gay6, I. Nathan7, E. Ream1, H. Terry4, 1King's College London, Florence Nightingale School of Nursing & Midwifery, London, United Kingdom, 2Crohn's and Colitis UK Trustee, Fatigue Steering Group, St Albans, United Kingdom, 3The Queen Elizabeth Hospital NHS Trust & Addenbrookes Hospital, Gastroenterology, King's Lynn & Cambridge, United Kingdom, 4Crohn's & Colitis UK Charity, CCUK, St Albans, United Kingdom, 5University College London, Gastroenterology, London, United Kingdom, 6Crohn's and Colitis UK, Fatigue Steering Group, St Albans, United Kingdom, 7University College London, Centre for Gastroenterology and Nutrition, London, United Kingdom

Background

Fatigue is one of the top complaints of people with inflammatory bowel disease (IBD) with more than 40% of patients in remission and 86% in active condition reporting fatigue. However patients report that their complaints of fatigue are often not addressed in clinical consultations. To date there are no studies exploring this topic from the clinician's perspective. This study aimed to gain an understanding of healthcare practitioners' (HCPs) perception of IBD fatigue as experienced by people with IBD, and to identify the range of methods that HCPs use to assess and manage fatigue.

Methods

Descriptive phenomenology was carried out to achieve the aims of the study. Purposive sampling was used to identify a range of professionals (gastroenterologists, IBD nurses, general practitioners, dietitians, psychologists and pharmacists). In-depth semi-structured interviews were conducted with 20 HCPs who work with people with IBD between June and December 2012. Interviews were audio recorded and transcribed verbatim. Colazzi's seven step framework was used to analyse data. The study was approved by the local university ethics committee.

Results

Three main themes and several sub-themes were identified. The main themes were: the phenomenon of fatigue as perceived by HCPs; the impact of fatigue on patients' lives as perceived by HCPs; and the methods used by HCPs to deal with fatigue. Fatigue was identified as an important, but difficult and often frustrating, symptom to understand. The study participants perceived fatigue as ‘such a complicated and complex thing’. HCPs reported that fatigue impacts on the emotional, private and public aspects of patients' functioning, however there were very few methods suggested on how to assess and manage the fatigue in a systematic way. Many expressed a desire for better education and a frustration at not being able to help patients more. There was consensus that managing fatigue should be a multi-disciplinary effort, but with little idea of clearly defined roles.

Conclusion

Despite fatigue being one of the symptoms most frequently reported by IBD patients, it remains poorly understood by HCPs, who find fatigue challenging and frustrating. There is a need for a systematic and structured assessment and management of this distressing symptom and HCPs should communicate with each other about care for each individual patient. There is a need for an assessment framework and for intervention strategies to be tested. It is essential for multidisciplinary team members to be involved in planning and managing coordinated care of patients reporting fatigue in IBD.