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Treat-to-target approach in IBD management may improve doctor-patient relationship
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Researchers have proposed that a “treat-to-target” strategy for the management of inflammatory bowel disease may lead to an improved doctor–patient relationship.
According to David T. Rubin, MD, FACG, and Noa Krugliak Cleveland, MD, from the University of Chicago Inflammatory Bowel Disease Center, the heterogeneity of IBD and the complexity of care for patients with IBD can contribute to a conflict between therapeutic recommendations and patient wishes; thus, preserving the doctor–patient relationship depends on adequate physician communication, respect for patient autonomy and fostering a productive shared decision-making interaction.
David T. Rubin
Noa Krugliak Cleveland
Rubin and Cleveland proposed that a treat-to-target approach, whereby agreed-upon objective targets of disease control are measured and serial adjustments to treatment are made, can improve the doctor–patient relationship.
“Such an approach allows the uncertainty and nonspecificity of symptom-based management to be replaced with a mutually agreed upon objective measure of disease activity, a greater understanding of specific motivations and fears of the patient, and an agreed upon time line during which a patient may explore alternative treatment options or a ‘wait and see’ approach,” they wrote. “Such a treat-and-monitor approach can clarify goals of therapy, enable objective measures of disease control that inform go/no-go decisions about ongoing treatments, and minimize exposure to side effects from ineffective therapy.”
To employ the treat-to-target approach with patients who refuse to follow treatment recommendations, the physician should:
- understand and address the patient’s fears and correct any misinformation;
- discuss objectively monitoring the disease in an agreed upon way with a biomarker target;
- agree on a time frame for exploring a different treatment option; and
- reassess the objective marker and repeat discussion of treatment recommendations.
If the objective goal is achieved by the different treatment strategy, then the approach can continue until the next assessment; otherwise, the patient may then be persuaded to follow a more conventional or evidence-based treatment.
“Dissemination of this approach to the [doctor–patient relationship] in IBD will require a large amount of education and some degree of retraining physicians and, ultimately, many other members of the complex multidisciplinary IBD team,” they concluded. “However, we believe that development of this approach to communication with patients is a necessary component of the ongoing efforts to characterize preferred disease activity measures and the ability of available therapies to achieve established goals.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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