Maria Barsky, MD1, Joseph Meserve, MD1, Angelina Collins, NP1, Siddharth Singh, MD2, Brigid Boland, MD1, William J. Sandborn, MD, FACG2, Parambir Dulai, MD2
1University of California San Diego, San Diego, CA; 2University of California San Diego, La Jolla, CA
Introduction: Fecal biomarkers are being increasingly suggested as alternatives to colonoscopy for disease activity assessments. We aimed to assess patient preferences between fecal testing and colonoscopy for disease activity assessments.
Methods: Prospective interview of UC and CD patients from a single tertiary referral center. A hierarchy matrix survey was built to understand patient preferences around decision making when choosing between approaches (fecal testing or colonoscopy) for achieving a specific goal (monitoring disease activity) based on pre-set criteria (accuracy, preparation, pain, complications). Presumed accuracy of fecal biomarkers was set to 80-90%, and rates of colonoscopy related complication were set to 1 in 100 or 1 in 1,000. Pair wise analyses were used to identify determinants of patient preference and thresholds of acceptability to change preferences.
Results: N=100, median age of 44 years (IQR 27-63) with median disease duration of 9 years (IQR 5-21). Disease activity at the time of survey was well distributed with 47% in clinical remission, 24% with mild and 29% with moderate-severe activity. Colonoscopy was the initial preference for 40% of patients and more often being preferred by CD patients (49% vs. 31%, p=0.069). When choosing between fecal testing or colonoscopy for disease activity assessment, accuracy was significantly more important than preparation, pain, or complications (p< 0.05), but preparation and pain were comparable to complications (p >0.20). After understanding the limitations in accuracy with fecal testing, 25 patients who initially chose fecal testing changed their preference to colonoscopy (p< 0.001) and at the completion of the survey a total of 65% chose colonoscopy over fecal testing. If the fecal test was wrong at most 1 in 20 times (5%), 40% of patients who ultimately chose colonoscopy were willing to undergo fecal testing. If the fecal test was wrong at most 1 in 50 times (2%), 66% of patients who ultimately chose colonoscopy were willing to undergo fecal testing.
Discussion: Accuracy appears to be the most important criteria for IBD patients when choosing monitoring strategies, followed by pain/preparation and risk of complications. A significant number of patients changed their preferences to colonoscopy after learning more about the diagnostic accuracy of current fecal testing for disease monitoring. A high degree of confidence is required of fecal test results for patients to choose this strategy.
Citation: Maria Barsky, MD; Joseph Meserve, MD; Angelina Collins, NP; Siddharth Singh, MD; Brigid Boland, MD; William J. Sandborn, MD, FACG; Parambir Dulai, MD. P2333 - COMPARISON OF PATIENT PREFERENCES BETWEEN STOOL TESTS AND COLONOSCOPY FOR ASSESSMENT OF DISEASE ACTIVITY IN INFLAMMATORY BOWEL DISEASES. Program No. P2333. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.