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Multicenter Study
. 2022 Jul 1;28(7):1053-1060.
doi: 10.1093/ibd/izab221.

Patients Prioritize a Low-volume Bowel Preparation in Colitis-associated Colorectal Cancer Surveillance: A Discrete Choice Experiment

Anouk M Wijnands  1 , Maarten Te Groen  2 , Yonne Peters  2 , Ad A Kaptein  3 , Bas Oldenburg  1 , Frank Hoentjen  4 , Maurice W M D Lutgens  5
Affiliations
Multicenter Study

Patients Prioritize a Low-volume Bowel Preparation in Colitis-associated Colorectal Cancer Surveillance: A Discrete Choice Experiment

Anouk M Wijnands et al. Inflamm Bowel Dis. .

Abstract

Background: Patients with inflammatory bowel disease (IBD) undergo surveillance colonoscopies at fixed intervals to reduce the risk of colorectal cancer (CRC). Taking patients' preferences for determining surveillance strategies into account could improve adherence and patient satisfaction. This study aimed to determine patient preferences for CRC surveillance in IBD.

Methods: We conducted a web-based, multicenter, discrete choice experiment among adult IBD patients with an indication for surveillance. Individuals were repeatedly asked to choose between 3 hypothetical surveillance scenarios. The choice tasks were based on bowel preparation (0.3-4 L), CRC risk reduction (8% to 1%-6%), and interval (1-10 years). Attribute importance scores, trade-offs, and willingness to participate were calculated using a multinomial logit model. Latent class analysis was used to identify subgroups with similar preferences.

Results: In total, 310 of 386 sent out questionnaires were completed and included in the study. Bowel preparation was prioritized (attribute importance score 40.5%) over surveillance interval and CRC risk reduction (31.1% and 28.4%, respectively). Maximal CRC risk reduction, low-volume bowel preparation (0.3 L laxative with 2 L clear liquid) with 2-year surveillance was the most preferred combination. Three subgroups were identified: a "surveillance avoidant," "CRC risk avoidant," and "surveillance preferring" groups. Membership was correlated with age, educational level, perceived CRC risk, the burden of bowel preparation, and colonoscopies.

Conclusions: Inflammatory bowel disease patients consider bowel preparation as the most important element in acceptance of CRC surveillance. Heterogeneity in preferences was explained by 3 latent subgroups. These findings may help to develop an individualized endoscopic surveillance strategy in IBD patients.

Keywords: Crohn’s disease; risk perception; screening; ulcerative colitis.

Plain language summary

This discrete choice experiment identified volume of bowel preparation as the attribute impacting patients’ preferences regarding colitis-associated colorectal cancer surveillance most. Three subgroups were identified with similar preferences and distinct clinical characteristics.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Attribute importance scores for total sample (A) and latent classes (B), percentages. Importance scores displayed for the total sample (A) and each subgroup (B; in %). A higher score indicates a higher importance of the attribute for patients relative to the other attributes.
Figure 2.
Figure 2.
Part-worth utility scores (0-centered), total sample and latent classes. Part-worth utility scores indicate the relative preference of a level within the attribute, with lower scores indicating a less preferred level.
See this image and copyright information in PMC

References

    1. Lutgens MW, van Oijen MG, van der Heijden GJ, et al. . Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis. 2013;19:789–799. - PubMed
    1. Jess T, Rungoe C, Peyrin-Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol. 2012;10:639–645. - PubMed
    1. Farraye FA, Odze RD, Eaden J, et al. ; AGA Institute Medical Position Panel on Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease . AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:738–745. - PubMed
    1. Maaser C, Sturm A, Vavricka SR, et al. ; European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] . ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019;13:144–164. - PubMed
    1. Siegel CA. Shared decision-making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options. Gut. 2012;61:459–465. - PubMed

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