Interactive decision aid fails to best standard education for biologic selection in IBD
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SAN DIEGO — A novel tool for educating patients with inflammatory bowel disease on biologic therapies failed to improve upon standard education with regard to shared decision-making, according to data presented at Digestive Diseases Week.
“For patients with moderate-to-severe IBD, there are multiple biologics that could be used to treat their condition,” Christopher Velasquez Almario, MD, of Cedars-Sinai Medical Center, told Healio. “However, the biologic options are all different in how they work, how they are given, and their side-effect profile.”
Almario noted that this can present challenges for doctors and patients in selecting a biologic option that best fits with the patient’s values and preferences. “Thus, to help support patients and doctors when selecting a biologic medication, we created a freely-available decision aid called IBD&Me.”
There are “two main parts” to the tool, according to Almario. “There is a ‘learn more’ section where we go over important topics such as what are biologics, when to take biologics, and risks of biologics, among others,” he said.
After patients review the educational material, they go through the second part, which is the IBD&Me Decision Tree. “This is an interactive test where patients see hypothetical biologic medications side by side and they choose which one they would prefer to use to treat their IBD,” Almario said. “Once they are done, IBD&Me creates their Personalized Report that shows what was most important to them when choosing a medicine.”
Patients can then share this report with their doctor so they can also see what matters most to the patient in a biologic treatment.
In the current multicenter, randomized controlled trial, the researchers compared the impact of IBD&Me with standard education protocols on how patients perceive shared decision-making.
The analysis included 152 patients overall, with 77 given IBD&Me and 75 given a biologics fact sheet from the Crohn’s and Colitis Foundation. Participants were seen at a tertiary referral center or an IBD Qorus clinic between March 5, 2019 and January 20, 2021, according to the findings.
Eligibility criteria included IBD symptoms within the past 30 days and a desire to discuss biologic treatment options.
Response of the 9-item SDM Questionnaire was the primary outcome, while the Decisional Conflict Scale and Patient Satisfaction Questionnaire Short Form were used to assess secondary endpoints.
Overall, 68.8% of patients reviewed IBD&Me and 72.0% reviewed the biologics fact sheet before their visit.
Results showed no difference between intervention groups with regard to shared decision-making, decisional conflict or patient satisfaction when examining the data pertaining to intention-to-treat, modified intention-to-treat and per-protocol perspectives.
The researchers also used the 7-point Likert scale to determine whether participants would recommend their intervention to another patient. Results showed that those in the IBD&Me group (5.8 ± 1.3; P = .90) were about as likely as those in the biologic fact sheet group (5.7 ± 1.2) to recommend their intervention.
“We did not find any difference in patients’ perceptions of shared decision-making between IBD&Me and static education,” Almario said. “While there are many potential reasons we did not find a difference between the arms, one reason may be that interactive components to IBD decision aids may not be necessary to improve shared decision-making and the resources needed to develop and maintain such components may be low yield.”
Almario suggested that further research into this topic is necessary. “However, it is possible that high-quality, yet static educational material may be sufficient for supporting shared decision-making between patients and their doctors,” he said.
It is important to note that most patients in the current study were already taking biologics, and, therefore, familiar with them, according to Almario. “Also, most patients in the trial were being seen in clinics with high levels of expertise in treating IBD,” he said. “Their physicians likely had considerable experience discussing the pros and cons of the biologic options with patients. Future studies may want to include physicians with a broader range of experience in managing moderate-to-severe IBD.”
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Almario, et al. Abstract 982. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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