Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer (CRC). Surveillance colonoscopy decreases the risk of developing CRC and increases the detection of CRC at an early stage. However, only a small proportion of eligible patients with IBD engage in surveillance colonoscopy as recommended by current practice guidelines. There is a need to identify effective approaches to surveillance colonoscopy and how to effectively communicate individualized CRC risk to IBD patients in order to reduce the mortality burden of this fatal IBD complication. My long-term goal is to conduct and implement research to reduce the incidence and mortality of IBD-associated CRC. My central hypotheses are that patient experiences influence acceptance of CRC surveillance colonoscopy, subgroups of IBD patients benefit from surveillance colonoscopy, and that a patient-centered communication tool using these factors can aid patient decision making regarding CRC surveillance.
The specific aims of my proposal are:
Aim 1 : Define IBD patient experiences throughout the process of surveillance colonoscopy.
Aim 2 (a): Compare the effectiveness of colonoscopy surveillance strategies on the yield of dysplasia or CRC, CRC stage, treatment, and CRC-related mortality in a national cohort of patients with IBD.
Aim 2 (b): Identify subgroups of patients with IBD who derive benefit (or harm) from surveillance colonoscopy.
Aim 3 : Translate patient experiences of colonoscopy and effectiveness of surveillance colonoscopy effectiveness into an IBD CRC communication tool for decision support. Future studies will test the effectiveness of the communication tool on CRC surveillance adherence, early stage CRC detection, and patient satisfaction with decision making. I will achieve these aims through a partnership with the Crohn's and Colitis Foundation of America to conduct in-depth interviews with patients with IBD regarding their experiences with colonoscopy and to conduct patient consensus panels to develop and refine a communication tool for CRC surveillance decision making. I will compare the effectiveness of colonoscopy surveillance strategies on outcomes of CRC in a cohort of approximately 63,000 patients with IBD in the national Veterans Health Administration datasets aided by natural language processing to define key IBD variables currently lacking using automated administrative data. I am a gastroenterologist pursing my career goal of becoming an independently funded investigator in IBD, with a specific focus on the development of patient-provider communication tools to improve CRC outcomes. To achieve my career goals, I will require protected time, mentorship, and formal research training in qualitative methods, comparative effectiveness analyses, patient engagement, and development of communication tools. With the support and protected time from the AHRQ PCOR K08 Award, I will be able to complete my proposed research and career training goals and secure independent funding.
Rates of inflammatory bowel disease (IBD) are rising in the U.S., and patients with IBD are at an increased risk of developing colorectal cancer. This project compares strategies using colonoscopy to reduce or prevent colorectal cancer among patients with IBD and investigates how patients' past experiences with colonoscopy influence their decision to have future colonoscopies. Development of a communication tool that can improve how patients understand their personal risks of colorectal cancer that their ability to make informed decisions could have a substantial public health impact.
| Govani, Shail M; Wiitala, Wyndy L; Stidham, Ryan W et al. (2016) Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease. Inflamm Bowel Dis 22:1923-8 |
