Do patients consider postoperative maintenance therapy for Crohn's disease worthwhile?

Authors

  • Erin D. Kennedy MD, PhD,

    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Theresa To PhD,

    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • A. Hillary Steinhart MD,

    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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  • Allan Detsky MD, PhD,

    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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  • Hilary A. Llewellyn-Thomas PhD,

    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Centre for the Evaluative Sciences, Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire
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  • Robin S. McLeod MD

    Corresponding author
    1. Department of Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario Canada
    2. Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
    • Department of Surgery, Mount Sinai Hospital, Suite 449, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
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Abstract

Background: Treatment decision making for postoperative Crohn's disease is complex because of the increasing number of maintenance therapies available with competing risk–benefit profiles. The main objective of this study was to determine the distribution of patients' preferences for selected postoperative maintenance therapies.

Methods: The study was a cross-sectional survey in which patients with Crohn's disease completed a standardized interview. Each participant completed 5 tasks that compared: (1) no medication and 5-ASA, (2) fish oil and 5-ASA, (3) metronidazole and 5-ASA, (4) budesonide and 5-ASA, and (5) azathioprine and 5-ASA. For each task, the minimum change in treatment effect size between the 2 treatments that the participant considered worthwhile was determined

Results: The distribution of the participants' preference scores varied widely for each task. When fish oil, metronidazole, budesonide, and azathioprine were considered equally effective to 5-ASA, 92.9%, 28.8%, 38.4%, and 19% of the participants, respectively, preferred these medications relative to 5-ASA. These percentages increased to 98.4%, 54.8%, 61.9%, and 50.8%, respectively, when fish oil, metronidazole, budesonide, and azathioprine were considered to offer a 5% absolute risk reduction relative to 5-ASA. Regression analysis did not identify any clinical or demographic variables predictive of the participants' treatment preferences.

Conclusions: The participants' preferences for postoperative maintenance therapies were widely distributed, and no clinical or demographic factors predicted these preferences. This emphasizes the need for effective communication between physician and patient in order to select the treatment options most consistent with a patient's informed preferences.

(Inflamm Bowel Dis 2007)

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