Shared Decision Making with IBS

IBS is a complex disorder that often requires a multi-faceted and personalized treatment plan.

From my experience, treatment bias plays a big role in how IBS patients are treated. Treatment Bias is a prejudice in favor of or against one treatment compared with another in a way that may be unfair or employed with a limited lens.

How about educating IBS patients about the various treatment options available to provide symptom relief? Then, they can be an educated participant in their own treatment plan. Seems so obvious, doesn’t it?

The patient-clinician partnership should be central to decision making. Clinicians should provide their clinical rationale for treatments offered to help educate the patient. This facilitates a team approach. The patient, of course, is an essential part of the team.

But often practitioner’s bias plays a role in what treatments are offered.

I believe, it is essential for IBS practitioner’s to stay abreast of the current research (this is a bit of a challenge as so many papers are published monthly) and help educate IBS patients on all evidenced-based options.

Last year at Digestive Disease Week (DDW), a group from the Netherlands presented on what I think is a wonderful project, called:  Reduce IBS Project: Multiple Therapy Choices and Shared Decision-Making Give IBS Patients Self Management and Better Quality of Life.

This pilot project evaluated the strategy of offering 10 IBS therapy options to patients and to have the patient select their top 3 choices for treatment.

Patients received electronic handouts of each therapeutic option so that they could educate themselves and then selected their 3 top options.

The 10 treatments offered included:

  • Broad IBS information
  • Elimination diet
  • FODMAP restricted diet
  • Probiotics
  • Hypnotherapy
  • Antibiotics
  • Peppermint oil
  • Spasmolytics (antispasmodics)
  • Amitriptyline (antidepressant)
  • Citalopram (antidepressant)

Patients were referred back to their GP who treated them with the 3 chosen treatments for 2 months.

In this pilot study, 217 IBS patients were included, 76% female.  The preferred therapy of choice were peppermint oil (51%), probiotics (49%), low FODMAP diet (46%), hypnotherapy (36%) and elimination diet (27%).

No surprise, patient’s appreciated having treatment options and their IBS quality of life symptoms improved by 13.7%. Time spent with the gastroenterologist was actually reduced from 45 minutes to 10 minutes. The number of colonoscopies was reduced as well from 25% to 15%.

This study reveals that nutritional treatment options are important to IBS patients. Comprehensive information about IBS therapies should be shared with IBS patients as well as adequate time to allow patients to ‘digest’ the different treatment options so they can select an option that is most suitable to their goals.

For the patient:  Does your IBS treatment team provide various options to help manage your symptoms? Or is it a one-size fits all approach?

For the practitioner: Does this article make you think about other options you might suggest or consider for your IBS patients?

Reference: DDW 2017 presentation 164. Otten, MH et al. Reduce IBS Project: Multiple Therapy Choices and Shared Decision-Making Give IBS patients Self Management and Better Quality of Life.