Louisiana State University Health Science Center, Department of Gastroenterology, New Orleans, LA, USA.
Inflamm Bowel Dis. 2020 Jan 1;26(1):147-149. doi: 10.1093/ibd/izz122.
Biologic therapy continues to be underutilized despite its efficacy and overall favorable side effect profile when compared with corticosteroids. Siegel et al found in a well-done, cross-sectional study that patients perceived that corticosteroids were more beneficial, more familiar, and less dreadful than biologics despite perceiving that corticosteroids are more risky. They also found that perception of risk may be influenced by a patient's personality trait. Patients who believe that their health is influenced by their own choices or behaviors perceived biologic therapy less scary compared with patients who believed their health is influenced by chance. Physicians and patients disagree about how much medication-related risk is tolerable for improvements on efficacy. However, they are both willing to accept risks for therapies that offer significant therapeutic benefit. Physicians are tasked to translate complex evidenced-based data accurately and should take into account a patient's personality trait in order to provide individualized care and help guide shared decision-making. Future research should assess physician's personality traits, treatment experiences, and perception of risks, benefits, and dread of IBD medications and how it influences shared-decision making.
尽管生物制剂的疗效确切，且总体副作用良好，但与皮质类固醇相比，生物制剂的使用仍不理想。Siegel 等人在一项精心设计的横断面研究中发现，尽管患者认为皮质类固醇的风险更高，但他们认为皮质类固醇比生物制剂更有益、更熟悉、更不可怕。他们还发现，对风险的感知可能会受到患者个性特征的影响。与那些认为自己的健康受机会影响的患者相比，认为自己的健康受自身选择或行为影响的患者认为生物制剂的可怕程度较低。医生和患者对于为了提高疗效而可以接受多大程度的与药物相关的风险存在分歧。然而，他们都愿意为提供显著治疗益处的疗法承担风险。医生的任务是准确地翻译复杂的基于证据的数据，并且应该考虑到患者的个性特征，以提供个性化的护理并帮助指导共同决策。未来的研究应该评估医生的个性特征、治疗经验以及对 IBD 药物的风险、获益和可怕程度的感知，以及这些因素如何影响共同决策。
