BACKGROUND: Treatment decisions for patients with ulcerative colitis (UC) depend on the disease severity. This observational, cross-sectional, web-based survey sought to provide insight into the real-world symptoms and clinical characteristics that factor into healthcare providers’ (HCPs) treatment choices for their patients with UC in the United States.
METHODS: Self-reported data were collected from HCPs using a standard web-based questionnaire between 21 November 2022 and 6 December 2022. Eligible HCPs were required to have treated at least 10 adult patients with UC per month, worked more than 20 hours per week in direct patient care; and be able to complete the survey in English. HCPs included gastroenterologists (GIs), primary care physicians (PCPs), internal medicine (IM) or family medicine (FM) physicians, nurse practitioners (NPs), or physician assistants (PAs). Questionnaire responses were summarized through descriptive statistics, and post hoc comparisons between HCP types (GIs, FM/IM/PCPs, PAs, NPs) were performed using binomial regression models without adjustment for multiple comparisons.
RESULTS: Among 459 HCPs (male: 47.9%; 30-49 years age-group: 55.1%), 55.3% were physicians, 22.7% were NPs, and 22.0% were PAs. Approximately, 50% of the HCPs described their primary medical specialty as primary care/family care, followed by 37.7% in gastroenterology, and 12.9% in IM. From a list of 13 symptoms, when asked to select three symptoms they considered most important in deciding a course of treatment for UC, HCPs chose rectal bleeding (60%), followed by cramping or other abdominal pain (45%), diarrhea (41%), anemia (34%), and bowel urgency (28%, Fig. 1). The proportions were similar across HCP types except a greater proportion of GIs (60%) selected diarrhea than the other specialties (NPs: 42%, P=0.0127; FM/IM/PCPs: 33%, P<0.0001; PAs: 32%, P<0.0001). Rectal bleeding (87.4%), clinical remission (86.7%), abdominal pain (81.4%), stool frequency (77.6%), bowel urgency (77.3%), mucosal appearance (72.9%), and histologic appearance (71.5%) were rated as “very important” or “extremely important” by HCPs for deciding treatment choices (Fig. 2). A higher percentage of GIs, PAs, and NPs rated several symptoms more frequently vs FM/IM/PCPs, including bowel urgency (GIs: P<0.0001; PAs: P=0.0182; NPs: P=0.0342), mucosal appearance (P<0.0001, P=0.0091; P=0.0009), and stool frequency (P=0.0013; P=0.0283; P=0.0114) as “very important” or “extremely important.”
CONCLUSION: Results suggest a need for education among some specialties, particularly FMs, IMs, and PCPs, about the clinical presentation of UC and most important symptoms to consider when deciding treatment options for patients with UC.
