Understanding Determinants of Patient Preferences Between Stool Tests and Colonoscopy for the Assessment of Disease Activity in Inflammatory Bowel Disease.
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 < 0.001). Across all sub-groups, accuracy was ranked as the top criterion when choosing between stool-based testing and colonoscopy for disease activity assessments. Most patients were willing to choose stool-based testing over colonoscopy for disease monitoring if the stool test was wrong at most 1 in 20 times (5% misclassification rate).


DISCUSSION
Accuracy is the most important criteria for IBD patients when choosing monitoring strategies, and a high degree of confidence is required of stool test results for patients to choose this strategy.
['Barsky|Maria|M|', 'Meserve|Joseph|J|', 'Le|Helen|H|', 'Collins|Angelina|A|', 'Singh|Siddharth|S|', 'Boland|Brigid|B|', 'Sandborn|William J|WJ|', 'Dulai|Parambir S|PS|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D003113:Colonoscopy D003625:Data Collection D005243:Feces D005260:Female D006801:Humans D015212:Inflammatory Bowel Diseases D008297:Male D008875:Middle Aged D057240:Patient Preference D055815:Young Adult
Preferences Biomarker Monitoring