Wissenschaftliche Zusammenfassung

The management of inflammatory bowel disease (IBD) has seen significant advancements with the emergence of new biological agents and small-molecule therapies that target different mechanisms of the inflammatory cascade. However, selecting the most appropriate treatment remains challenging due to patient variability, prior therapy exposure, a lack of comparative studies, and the chronic nature of the disease. Each therapeutic option carries potential risks, including adverse effects and long-term health concerns for patients.  

The STRIDE II (Selecting Therapeutic Targets in Inflammatory Bowel Disease) guidelines define therapeutic goals associated with improved long-term outcomes (Turner et al., 2019). Achieving these objectives, however, poses significant challenges. Clinicians must balance aggressive treatment strategies against potential adverse events such as infections and malignancies, whereas patients must navigate treatment-related risks and quality-of-life considerations (Song & Wu, 2022).

Shared decision-making (SDM) is recognized as a crucial element in the management of chronic diseases (Elwyn et al. 2012), promoting informed and collaborative treatment choices. Ideally, SDM integrates both clinical expertise and patient preferences, including risk tolerance and lifestyle factors. However, there is a paucity of empirical data exploring patient preferences in IBD treatment, particularly concerning how patients weigh the trade-offs between efficacy and safety when selecting therapies (Fiorino et al. 2024).

One of the primary challenges in treatment decision-making is the divergence in priorities between healthcare providers and patients. Research suggests that while clinicians emphasize long-term disease control, patients often prioritize symptom resolution, potentially leading to mismatched treatment goals (Casellas et al. 2017).

Risk perception is another factor that complicates the decision-making process. Many highly effective IBD therapies are associated with potential risks, including increased susceptibility to infections and, in rare cases, heightened risks of malignancies. The risk-benefit assessments between clinicians and patients may vary significantly, with clinicians more likely to tolerate higher side effect risks in pursuit of sustained remission, while patients often seek to minimize adverse effects, particularly when the risks are inadequately communicated (D'Amico et al. 2023).

In addition to the relationship between patient and clinician, systemic healthcare factors also influence treatment decision-making. Variables such as medication availability, cost considerations, and access to specialized care play significant roles in shaping treatment recommendations and decisions.

The CHOOSE survey aims to systematically compare the decision-making processes of clinicians and patients in the management of IBD, identify key treatment priorities, and highlight areas where communication gaps exist. The study attempts to bridge the gap between clinical priorities and patient expectations, ensuring a more patient-centered approach to IBD treatment.

Referenzen

Turner, D., D. Ricciuto, J. Lewis, and M. Feagan. 2019. “STRIDE-II: An Update on Therapeutic Targets in Inflammatory Bowel Disease.” Journal of Crohn’s and Colitis 13(10): 1279-1287.

Song, K., and D. Wu. 2022. “Shared Decision-Making in the Management of Patients with Inflammatory Bowel Disease.” World Journal of Gastroenterology 28(8): 896-910.

Elwyn, G., A. Frosch, R. Thomson, J. Joseph-Williams, and C. Lloyd. 2012. “Shared Decision-Making: A Model for Clinical Practice.” Journal of General Internal Medicine 27(10): 1361-1367.

Fiorino, S., L. Danese, G. Peyrin-Biroulet, and M. Feagan. 2024. “Patient Preferences for Treatment Attributes in Inflammatory Bowel Disease: Results From a Large Survey Across Seven European Countries Using a Discrete Choice Experiment.” Clinical Gastroenterology and Hepatology 22(1): 59-71.

Casellas, F., J. Barreiro-de Acosta, M. Feagan, and S. Panés. 2017. “Understanding Patient Preferences for the Treatment of Inflammatory Bowel Disease.” The American Journal of Gastroenterology 112(11): 1601-1611.

D’Amico, F., S. Fiorino, G. Peyrin-Biroulet, and L. Danese. 2023. “Risk-Benefit of IBD Drugs: A Physicians and Patients Survey.” Journal of Crohn’s and Colitis 17(3): 415-423.