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P560 Patients and gastroenterologists' perceptions of treatments in Inflammatory Bowel Disease: Do doctors and patients speak the same language?

C. Vaucher1, M.H. Maillard2, M. Timmer1, F. Froehlich3, B. Burnand1, P. Michetti4, V. Pittet*1

1Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 2Lausanne University Hospital, Department of Gastroenterology & Hepatology, Lausanne, Switzerland, 3University Hospital Basel , Division of Gastroenterology & Hepatology, Basel, Switzerland, 4Clinique La Source-Beaulieu, Crohn and Colitis Center, Lausanne, Switzerland

Background

Perceptions of risks and benefits of therapies may differ between gastroenterologists (GIs) (as treatment providers) and inflammatory bowel disease (IBD) patients, (as treatment consumers). Very few studies have focused on the patients' point of view on medication and prioritization of outcomes. The aim of this study was to explore and compare Swiss GIs' and patients' perceptions of appropriateness (i.e., balance of risks and benefits) of treatments for IBD.

Methods

This study used qualitative methods. Four vignette cases were drawn from typical clinical situations and formed the basis of three focus group discussions, managed by a psycho-sociologist, between either GIs (n=7), ulcerative colitis patients (UC-p, n=8) or Crohn's disease patients (CD-p, n=6). The contents of the three focus group discussions were compared using qualitative content analysis.

Results

UC-p agreed more often with GIs' treatment choices than CD-p. Most agreement was found around 5-ASA therapy, considered as the most convenient and safest drug to take. For CD-p, 5-ASA was often considered to be a placebo. For UC-p, topical 5-ASA was seen as a temporary solution, neither comfortable nor practical when professionally active; longer-term treatment with oral 5-ASA was preferred to azathioprine by both physicians and patients. Both also perceived azathioprine as the treatment for which the risks versus benefits is the highest; concerning anti-TNFs, the main risk perceived by patients was related to a potential loss of response. Divergences between GIs' and patients' opinions were observed on two main issues: 1) stop of treatment: UC-p did not easily concur with stopping the treatments, which differed from the GIs' expectation of patients' perception; on the contrary, CD-p were more prone to consider stopping treatment than GIs; 2) perception of outcomes: physicians aimed at obtaining a histological remission, and had a focus on long-term objective goals. In contrast, patients' expectations were of shorter term and focused on clinical remission. Patients' expectations of follow-up mainly concerned stress management and nutritional advice, in addition to a need for more information on the effects of treatments.

Conclusion

In the majority of cases, patients and GIs agreed on perception of IBD treatments. However, GIs seemed more concerned about objective and scientific measures of remission whereas IBD patients focused on quality of life and social outcomes when it came to evaluating a therapy. Better communication about those different goals and expectations may improve patients' adherence to therapy as well as physician-patient relationship, leading to better satisfaction with general healthcare.