Shared decision making & CD treatment choices

February 21, 2023

Issue 04

Clinical Question

How does shared decision making affect Crohn’s disease patients’ treatment choices?

Editor’s Bottom Line

Using decision aids to educate IBD patients about the risks and benefits of alternate strategies leads to different treatment choices. This may be time well spent.

Reference

Zisman-Ilani Y, Thompson KD, Siegel LS, et al. Crohn’s disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial. Aliment Pharmacol Ther. Epub ahead of print Nov 14, 2022; https://onlinelibrary.wiley.com/doi/abs

Synopsis

Shared decision making (SDM) models are intended to enhance data and information sharing between patient and physician to help patients make evidence-based decisions that align with their preferences and priorities. In this study, researchers at eight academic centers and six community-based gastroenterology practices in the United States enrolled 158 recently-diagnosed adult Crohn’s disease (CD) patients who were eligible to receive immunomodulator or biologic treatment. They randomized 99 patients to receive care under an SDM model and 59 patients to undergo standard patient education.

Those in the SDM group were provided with a web-based decision aid consisting of a 20-minute video describing available the benefits, harms and uncertainties of available treatment options based on the existing evidence. They were also provided with graphic representation of their risk of developing CD complications based on outcomes of the Personalized Risk and Outcome Prediction Tool (PROSPECT), a web-based resource that predicts risk of complications based on a patient’s clinical, serologic and genetic characteristics.

Findings showed that 25% of those in the SDM group chose to receive combination therapy with a biologic and immunomodulator, compared to 5% of patients in the standard care group (p<0.001). Roughly half of participants in either group selected biologics as their treatment and 6% of patients in the SDM group chose not to receive CD-targeted therapy, compared to 40.7% of those in the control arm (p<0.001). Six percent of SDM group patients and 1% of the control group chose monotherapy with an immunomodulator.

Patient surveys performed throughout the study showed that patients in the SDM group had significantly less “decisional conflict” than those in the control group. Most patients in the SDM group said the PROSPECT tool and the decision aid increased their understanding of CD. Roughly 70% of patients in both groups said their planned treatment was what they wanted.

There were non-significant trends towards improved patient-reported outcomes scores, less steroid use, fewer surgeries and fewer hospitalizations in the SDM group.

Details

Study Design: Cluster-randomized trial

Funding: The Agency for Healthcare Research and Quality and the National Institute of Mental Health

Allocation: Randomized

Setting: Multicenter

Level of Evidence: 1b