P480 Goals of treatment: preferences of inflammatory bowel disease patients
F. Casellas*1, 2, C. Herrera de Guise1, V. Robles1, E. Navarro1, N. Borruel1
1Hospital Universitari Vall d’Hebron, Unitat Atenció Crohn-Colitis, Barcelona, Spain, 2Hospital Universitari Vall d’Hebron, Barcelona, Spain
From a physician’s perspective, the aim of the treatment of inflammatory bowel disease (IBD) is to achieve predefined objective targets, such as mucosal healing or histological healing. However, from a patient’s perspective these objectives may not be the most valued. Although there is scarce information relative to the patient’s goals of treatment, it is usually assumed that patients want control of symptoms and improvement on quality of life. There is a lack of information relative to what symptoms patients find more disturbing, or which attributes of therapy are the most valued by IBD patients. Aim: to stratify the priority that IBD patients assign to different symptoms and treatment attributes.
A prospective, observational, anonymised study in non-preselected consecutive outpatients with Crohn’s disease (CD) and ulcerative colitis (UC) was conducted. After written consent was obtained, patients answered a short survey and were asked to indicate their 2 most preferred objectives of the therapy.
In total, 83 patients (37 UC and 46 CD) were included. Most patients (89%) were in clinical remission. Treatment includes salicylates (13%), thiopurines (9 %), anti-TNF agents (73%), and other biologics (5%). The 4 most important symptoms that patients wanted to be controlled with their treatment were abdominal pain (21 %), diarrhoea (18 %), urge to have a bowel movement (18%) and fatigue (14%). Patients were also asked to select the 2 top outcomes from a predefined list, and the most important for patients were improvement of quality of life (46%), complete resolution of symptoms (35%), prevent flares (32%), and avoid surgery (26%). Only 9 % of patients considered having a normal colonoscopy as the preferred outcome.
Abdominal pain is the most important symptom for patients with IBD. Improvement of quality of life and complete control of symptoms are the highest priority outcomes. In contrast, medical objective targets, such as mucosal healing, are not a priority for patients.