Picoraro Joseph A, Rosh Joel R
aDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Medical Center, New York City, New York bDivision of Gastroenterology and Nutrition, Goryeb Children's Hospital, Morristown, New Jersey, USA.
Curr Opin Pediatr. 2017 Oct;29(5):572-577. doi: 10.1097/MOP.0000000000000524.
Treatment options for inflammatory bowel disease (IBD) have rapidly expanded as the treatment paradigm has shifted from controlling symptoms to reducing lifetime inflammatory burden. Families are confronted with the actual and perceived risks of this ever-expanding array of choices. We aim to review the shared decision-making process in pediatric IBD to ensure an optimal therapeutic plan for the child and their family.
Mucosal healing is a critical treatment target in pediatric IBD but it may not coincide with clinical symptoms. Evidence-based therapies carry important risks, some of which may be less severe than previously suspected, and a family's understanding of these risks plays a crucial role in how they make health decisions. To form an effective shared therapeutic plan, the physician must incorporate an understanding of the values of both the child and family along with their lived experience of illness.
To limit harm and promote health in pediatric IBD, the physician must communicate collaboratively with the child and their family to form mutually understood goals of care - both subjective experiential and objective biological - and appreciate actual and perceived risks of treatment options to effectively educate families and navigate toward the best treatment choices. VIDEO ABSTRACT.
随着治疗模式从控制症状转向减轻终身炎症负担，炎症性肠病（IBD）的治疗选择迅速增加。家庭面临着这一不断扩大的选择范围所带来的实际和感知风险。我们旨在回顾儿科IBD中的共同决策过程，以确保为儿童及其家庭制定最佳治疗方案。
黏膜愈合是儿科IBD的关键治疗目标，但它可能与临床症状不一致。循证疗法存在重要风险，其中一些风险可能没有之前怀疑的那么严重，而家庭对这些风险的理解在他们做出健康决策的方式中起着关键作用。为了形成有效的共同治疗方案，医生必须了解儿童和家庭的价值观以及他们的疾病生活经历。
为了在儿科IBD中减少伤害并促进健康，医生必须与儿童及其家庭进行协作沟通，以形成双方都理解的护理目标——包括主观体验和客观生物学方面的目标——并了解治疗选择的实际和感知风险，从而有效地教育家庭并做出最佳治疗选择。视频摘要。
