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Proximity to Disease and Perception of Utility: Physicians' vs Patients' Assessment of Treatment Options for Ulcerative Colitis

Brown, Lindsay Kennedy B.A.1; Waljee, Akbar K. M.D., M.Sc.2; Higgins, Peter D. R. M.D., Ph.D., M.Sc.2; Waljee, Jennifer F. M.D., M.P.H.3; Morris, Arden M. M.D., M.P.H3

doi: 10.1097/DCR.0b013e31823436a8
Original Contribution

BACKGROUND: Physician values regarding the benefit of continued medical therapy vs colectomy for moderate ulcerative colitis have not been defined. If physicians perceive these states differently than patients, their therapeutic recommendations may not align with patient values.

OBJECTIVE: This study aimed to compare physician and patient willingness to trade life years with moderately active ulcerative colitis vs undergoing colectomy.

DESIGN: This survey of physicians' and patients' utility values used standardized scenarios for moderately active ulcerative colitis and colectomy.

SETTING: The investigation was conducted at a tertiary academic medical center.

METHODS: Gastroenterologists, colorectal surgeons, and patients with ulcerative colitis who were either living with moderate disease or were postcolectomy completed the survey.

MAIN OUTCOME MEASURES: Utility values were measured by the use of the time trade-off method.

RESULTS: We surveyed 17 physicians, 150 postcolectomy patients, and 69 patients with moderate ulcerative colitis. Utility values for ulcerative colitis and colectomy states were (0.87, 0.95), (0.86, 0.92), and (0.91, 0.91). On average, physicians and postcolectomy patients assessed the utility of life with ulcerative colitis more poorly than the postcolectomy state. Patients with moderately active ulcerative colitis who had not undergone colectomy viewed both health states equally.

LIMITATIONS: This study was limited by the physician subject sample size.

CONCLUSIONS: Patients living with moderate ulcerative colitis value the pre- and postcolectomy states differently than physicians and postcolectomy patients. Recognizing the differences between their own and patients' values may help physicians to better counsel patients preoperatively. In addition, exposure to postcolectomy patients may help those with moderate disease who are weighing the comparative benefits of colectomy.

1 University of Michigan Medical School, Ann Arbor, Michigan

2 Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

3 Department of Surgery, University of Michigan, Ann Arbor, Michigan

Funding/Support: This work was supported by The American Society of Colon and Rectal Surgeons Limited Project Grant 078 (to A.M.M.). Opinions expressed are those of the authors and not The American Society of Colon and Rectal Surgeons.

Financial Disclosures: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Minneapolis, MN, May 15 to 19, 2010.

Correspondence: Arden M. Morris, M.D., M.P.H., 1600 Plymouth Rd, Building 520, 3165, Ann Arbor, MI 48109. E-mail: ammsurg@umich.edu

© The ASCRS 2011