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Journal of Crohn's and Colitis: 9 (8)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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5.425

Published on behalf of

What do changes in inflammatory bowel disease management mean for our patients?

Subrata Ghosh, Geert D'Haens, Brian G. Feagan, Mark S. Silverberg, Eva M. Szigethy
DOI: http://dx.doi.org/10.1016/S1873-9946(12)60504-2 S243-S249 First published online: 1 February 2012

Abstract

Treatment goals in Crohn's disease are evolving beyond the control of symptoms. A treat-to-target approach to management that features earlier initiation of TNF antagonist therapy will enable resolution of objective parameters of inflammation. The decision to initiate anti-TNF therapy should be based on a patient-specific assessment of risks and benefits. This paradigm necessitates a complex process, influenced by multiple factors that include the quality of data available, physicians' and patients' knowledge of the data, and the preferences and values of patients, physicians and society. The potential ‘opportunity cost’ resulting from a delay in initiation of effective therapy, a consideration that has been neglected in the past, must also enter into the equation. Our evolving approach to the management of Crohn's disease challenges patients to participate in the decision-making process and to become an active partner in their care. Ideally, this evolution should occur within the context of an enduring physician/patient relationship that is based on mutual trust. Motivational communication provides a useful technique to improve dialogue and collaboration between healthcare professionals and patients, and may help to engage and motivate patients to commit to managing their disease.

Keywords
  • Benefit/risk
  • Crohn's disease
  • Inflammatory bowel disease (IBD)
  • Medical decision-making
  • Motivational communication
Abbreviations
  • CD
  • Crohn's disease
  • IBD
  • inflammatory bowel disease
  • OR
  • odds ratio
  • PY
  • person years
  • RCT
  • randomized clinical trial

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