Understanding Determinants of Patient Preferences Between Stool Tests and Colonoscopy for the Assessment of Disease Acti
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ORIGINAL ARTICLE
Understanding Determinants of Patient Preferences Between Stool Tests and Colonoscopy for the Assessment of Disease Activity in Inflammatory Bowel Disease Maria Barsky1 · Joseph Meserve1 · Helen Le1 · Angelina Collins1 · Siddharth Singh1 · Brigid Boland1 · William J. Sandborn1 · Parambir S. Dulai1 Received: 29 May 2020 / Accepted: 19 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and Aims Evidence is now available in support of using fecal biomarkers to monitor disease activity in inflammatory bowel disease (IBD). Patient adherence is often cited as a barrier to implementation. We assessed patient determinants for using stool tests to monitor disease activity. Methods Prospective interview of IBD patients using an analytic hierarchy matrix survey built to understand preferences for choosing between stool testing or colonoscopy for monitoring disease activity, after considering different test criteria (accuracy, preparation, pain, complications). Theoretical thresholds of misclassification were posed to patients to see how they might consider shifting from colonoscopy to stool testing. Results A total of 100 patients (n = 51 CD, n = 46 male) were interviewed with median age and disease duration of 44 years (IQR 27-63) and 9 years (IQR 5-21), respectively. Stool-based testing was preferred over colonoscopy by 60% initially; however, a majority of participants changed their choice to colonoscopy after learning more about the diagnostic performance of currently available stool tests for disease monitoring (p 2 prior biologics, n (%) 1 prior biologic, n (%) Patients with prior surgeries, n (%) Average number of colonoscopies in last 5 years Disease severity Remission, n (%) Mild, n (%) Moderate, n (%) Severe, n (%)
Table 2 Global priorities for criterion based on key sub-groups 54 (54) 46 (46) 48 (48) 51 (51) 1 (1) 44.3 (18–80) 14.2 (0–52) 49 (49) 27 (27) 33 (33) 4.27 (0–12) 47 (47) 24 (24) 17 (17) 12 (12)
IBD: Inflammatory bowel disease; CD: Crohn’s disease; UC: ulcerative colitis; Disease severity—categorized based on the Crohn’s Disease Activity Index Patient Reported Outcome sub-scores for Crohn’s disease and the Partial Mayo score for Ulcerative Colitis
activity at the time of the survey was well distributed with 47% in clinical remission, 24% with mild activity, and 29% with moderate-severe activity. Recruitment occurred in the clinic setting for 65% of patients with the remaining 35% of patients being recruited and surveyed in the endoscopy suite immediately prior to undergoing a colonoscopy.
Baseline Patient Preference Stool testing was preferred for disease activity assessment in 60% of patients, with the remainder choosing colonoscopy. Colonoscopy was preferred by 49% of CD patients (n = 25/51) as compared to 31% of UC patients (n = 15/48, p = 0.10). Stool testing was preferred by 66% of patients in clinical remission (n = 31/47) versus 55% of those with active symptoms (n = 29/53, 55%; p = 0.31). Stool testing was preferred
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