DOP068 Crohn's disease decision aid leads to more patients choosing combination therapy in a cluster randomised controlled trial. (16th January 2018)

• Record Type: Journal Article
• Authors: Siegel, C A; Thompson, K D; Siegel, L S; MacKenzie, T; Dubinsky, M C
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S076
• Page End: S077
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.105
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Data support the use of early intensive therapy with a combination of an anti-tumour necrosis factor agent and an immunomodulator (IM) for the highest chance of achieving steroid free remission in patients with Crohn's disease. However, this approach is used infrequently, likely related to a combination of reasons including patient and provider concerns about adverse events associated with these drugs, and the inability to stratify patients with low vs. high risk of developing complications of their disease. To address these challenges, a decision aid including an online program reviewing benefits and risks of treatment options combined with a personalised risk prediction tool (PROSPECT) for Crohn's disease was developed. The aim of this study was to determine the influence of this decision aid on the proportion of patients choosing combination therapy for treatment of their Crohn's disease. Methods: Patients with Crohn's disease were prospectively recruited from 16 GI practices across the US (8 academic, 8 community based). To meet inclusion criteria, all patients had to be within 15 years of diagnosis, without any current or prior disease complications, not currently on IMs or biologics but considered a candidate for these treatments by their provider. This study was a cluster-randomised trial stratified by practice type, with 8 practices in the intervention arm (received Decision Aid) and 8 practices in the control arm (standard of care). Results: A total of 202 patients were recruited over a 3-year period, approximately 2:1 in favour of intervention (133) vs. control (69). Demographics were similar between groups (Table 1), with more women in the control group and slightly shorter disease duration in the intervention group. For the primary outcome, 25% of patients in the intervention group chose combination therapy as compared with 5% in the control group ( p = 0.002). In the intervention group, 1% of patients chose no therapy directed at Crohn's disease vs. 17.5% in the control group ( p < 0.001). There was lower decision conflict in the intervention group (31.4 v 33.9, p = 0.04). For the intervention group, patients consistently reported that the PROSPECT tool (87%) and Crohn's disease online program (98%) increased understanding of their disease. Conclusions: The Crohn's disease decision aid consisting of the online program and PROSPECT tool led to a significantly higher proportion of patients selecting combination therapy for treatment, lower decision conflict amongst participants, and increased understanding of their disease.