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N09 IBD nurse intervention for patients assigned to biologic therapy decreases uncertainty and improves patient-reported outcomes

R. Barkan*1, I. Goren1,2, I. Avni Biron1,2, Y. Snir1,2, Y. Broitman1,2, H. Leibovitzh1,2, H. Banai Eran1,2, M. Aharoni Golan1,2, M. Siterman1,2, R. Hazan1, T. Pfeffer Gik1,2, L. Godny1,2, I. Dotan1,2, H. Yanai1,2

1Rabin Medical Center, IBD Center, Division of Gastroenterology, Petah-Tikva, Israel, 2Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel

Background

Commencing biologics in patients with inflammatory bowel diseases (IBD) is a major milestone that carries concerns due to multiple uncertainties. Data regarding psychological factors associated with doubts and reservations, and coping tools to overcome these challenges are scarce.

Methods

We launched a prospective randomised controlled study allocating adult patients with IBD for whom biologic therapy was recommended in our tertiary referral centre, to either standard or intensified IBD-nurse care. The standard IBD-nurse care includes a comprehensive walk-through explanation of the recommended treatment plan. In the intensified intervention we added one IBD-nurse visit and two follow-up phone calls for check-ups and updates. Patients’ uncertainty score, measured by Mishel uncertainty in illness Scale,1,2 and patients’ reported outcome measures (PROMs), assessed by the IBD disk,3 were evaluated in both groups at recruitment and at Week 14 after commencing therapy. Differences between scores at recruitment and at Week 14 were used to assess the impact of the IBD-nurse care.

Results

A total of 76 patients were recruited over 8 months' period, of whom 34 patients completed 14 weeks follow-up after biologic therapy initiation. Age, baseline C-reactive protein, haemoglobin and faecal calprotectin levels and types of biologics did not differ between the standard and intensified groups at baseline. Uncertainty scores significantly improved within each group at Week 14: ∆ in the standard group- 0.428 (IQR 0.515 −0.767), p = 0.001, and ∆ in the intensified group - 0.428 (IQR 0.089–0.767), p = 0.002. The domains regulating defaecation and emotions were stable throughout the follow-up period in the intensified group but have deteriorated in the standard group (∆:0 [-1.5 -3.5], p = 0.021 vs. 1 [-2.0–4.5], p = 0.018, and 0 [−3.0 −2.5], p = 0.004 vs. 1 [0.0–2.5], p = 0.152, respectively). The domains energy and sexual dysfunction improved in the intensified group compared with the standard group (∆: −1 [−4.0 −3.0], p = 0.001 vs. 1 [−4.0–3.5], p = 0.015, and −1 [-3.0–0] p = 0.005, vs. 0 [−2.0–2.0], p = 0.411, respectively).

Conclusion

IBD-nurse care is associated with improvement in uncertainty scores among patients commencing biologic therapy. Intensified IBD-nurse care is associated with even greater improvement in PROMs like managing defection, well-being and sexual dysfunction. IBD-nurse care should be routinely implemented in the multi-disciplinary care scheme for patients with IBD.

References

1. Mishel MH. The measurement of uncertainty in illness. Nursing Res 1981;30:258–263.

2. Giammanco MD, Gitto L, Barberis N, et al. Adaptation of the Mishel Uncertainty of Illness Scale (MUIS) for chronic patients in Italy. J Eval Clin Practice, 2015;21:649–655.

3. Ghosh S, Louis E, Beaugerie L, et al. Development of the IBD disk: a visual self-administered tool for assessing disability in inflammatory bowel diseases. Inflam Bowel Dis 2017;23:333–40.