A key element to optimizing the management of IBS is to have a strong physician-patient relationship that allows professional advice to be individualized. “IBS is a chronic condition for which there are many treatments, but there is no ‘one size fits all’ therapy,” explains Daniel Keszthelyi, MD, PhD. “In addition, adherence to IBS treatments may be suboptimal if patients aren’t asked about their preferences prior to initiating therapy. This highlights the importance of exploring patient preferences to improve how we manage individuals with IBS.”
Few studies have examined preferences for treatment among patients with IBS and the mode of information delivery they prefer. “Qualitative research is essential to tailoring treatment to the individual needs of patients with IBS,” says Dr. Keszthelyi. “Conducting focus group interviews is a well-established technique for qualitative studies.”
For a study published in BMC Gastroenterology, Dr. Keszthelyi and colleagues used focus group interviews to qualitatively assess the needs of patients with IBS regarding their preferences for healthcare delivery. In total, 24 participants were included, 23 of which had IBS and one participant was the mother of a patient diagnosed with IBS. Most participants were female, middle-aged, had an average IBS symptom severity score of 278 (normal range, 0–500), and suffered from IBS for a mean duration of 18 years.
Patients Want to Be Taken More Seriously
The study group clustered their results on patient perspectives from the focus group interviews into five themes: 1) clear communication, 2) a multidisciplinary treatment team, 3) expert healthcare providers and centers of expertise, 4) focus on scientific research, and 5) IBS information tools for patients (Figure). Incorporating these items into clinical practice may enable patients to better control their symptoms and improve coping strategies, the researchers note.
“Our most important finding was that many patients with IBS feel they aren’t taken seriously by their healthcare professionals,” Dr. Keszthelyi says. “They often don’t receive sufficient information from their healthcare provider, and it can take a long time before patients find an effective way to manage their symptoms. Since there are no specific biomarkers for IBS, the diagnosis is often one of exclusion. Diagnostics like stool tests or colonoscopies may be used to exclude organic diseases, such as Crohn’s disease or cancer. After a round—or sometimes several rounds—of negative test results, patients may be told there is nothing wrong with them, which makes them feel like their symptoms are dismissed and delegitimized.”
Be Proactive When Diagnosing & Treating IBS
According to Dr. Keszthelyi, many patients never receive a formal diagnosis of IBS, meaning they will not receive adequate treatment to manage their symptoms. “If someone presents with IBS symptoms, it’s important for doctors to make a positive diagnosis using the Rome criteria and then explicitly tell patients about their management plan,” he says. “If symptoms are compatible with IBS, patients should be informed that a few additional tests will be done to ensure no other diseases are present. While waiting for results from these diagnostics, clinicians can provide patients with educational materials to introduce them to treatment options that may be considered for their IBS symptoms.”
After diagnostics tests rule out other diseases, Dr. Keszthelyi recommends initiating treatment with an option that is preferred by patients. “After IBS is confirmed, preferences for treatment should be discussed, and we should offer guidance on what is most likely to help,” he says. “It’s also important to address any misbeliefs about IBS from patients. For example, some patients may not recognize that coloscopy is not needed to diagnose IBS.”
Dr. Keszthelyi says future research should investigate if digital instruments can be used as supportive care for IBS. “It’s important to direct patients to effective self-support management strategies, such as online treatment forms,” he says. “We’re also testing the clinical efficacy of an online hypnotherapy tool that might be beneficial in IBS care. In addition, interventions are needed to increase physician confidence in diagnosing IBS. Making diagnoses based on symptoms can leave clinicians unsure of the best approach and vulnerable to missing other disorders that could present with symptoms of IBS. The development of an easy-to-use diagnostic support tool that is readily available during consultations could be very helpful in this regard.”