Rohatinsky Noelle, Zelinsky Sandra, Dolinger Michael, Christensen Britt, Wilkens Rune, Radford Shellie, Dubinsky Marla, Novak Kerri
College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
University of Calgary, Calgary, Alberta, Canada.
Crohns Colitis 360. 2023 Feb 25;5(2):otad012. doi: 10.1093/crocol/otad012. eCollection 2023 Apr.
Strategies incorporating objective disease monitoring in Crohn's disease (CD), beyond clinical symptoms are important to improve patient outcomes. Little evidence exists to explore patient understanding of CD treatment goals, nor preferences and experiences with monitoring options. This qualitative study aimed to explore patient experiences and preferences of CD monitoring to inform monitoring strategies, improve patient engagement, and optimize a patient-centered approach to care.
This study used a patient-oriented, qualitative descriptive design. Convenience and snowball sampling were used to recruit adult participants diagnosed with CD who had experience with at least 2 types of disease monitoring. Online focus groups were conducted and data were analyzed using thematic analysis.
This international study included 37 participants from Australia, Canada, United Kingdom, and the United States. Overall, participants preferred more noninvasive types of monitoring [eg, intestinal ultrasound (IUS)] but were willing to undergo more invasive monitoring (eg, colonoscopy) if required. To improve disease monitoring, participants wanted increased access to IUS, establishment of a patient-centered interdisciplinary team and access to information and self-testing. Participants identified challenges with communication between patients and providers and stressed the importance of participating in shared decision making and being equal team members in their care.
It is imperative to incorporate patient-driven preferences into how we can best structure monitoring strategies, to ensure equitable access to those preferred modalities and embrace a shared decision-making approach to disease management in CD.
在克罗恩病(CD)中,除临床症状外纳入客观疾病监测的策略对于改善患者预后很重要。目前几乎没有证据探讨患者对CD治疗目标的理解,以及对监测选项的偏好和体验。这项定性研究旨在探讨患者对CD监测的体验和偏好,为监测策略提供信息,提高患者参与度,并优化以患者为中心的护理方法。
本研究采用以患者为导向的定性描述性设计。采用便利抽样和滚雪球抽样的方法招募有至少两种疾病监测经验的成年CD患者。进行了在线焦点小组讨论,并使用主题分析法对数据进行分析。
这项国际研究包括来自澳大利亚、加拿大、英国和美国的37名参与者。总体而言,参与者更喜欢更多非侵入性的监测类型[如肠道超声(IUS)],但如果需要,也愿意接受更具侵入性的监测(如结肠镜检查)。为了改善疾病监测,参与者希望增加IUS的可及性,建立以患者为中心的跨学科团队,并获取信息和进行自我检测。参与者指出了患者与医护人员沟通方面的挑战,并强调了参与共同决策以及在其护理中成为平等团队成员的重要性。
必须将患者驱动的偏好纳入我们构建最佳监测策略的方式中,以确保公平获得那些首选方式,并在CD疾病管理中采用共同决策的方法。