Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12899-12908
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12899
Do inflammatory bowel disease patient preferences from treatment outcomes differ by ethnicity and gender? A cross-sectional observational study
Timna Naftali, Vered Richter, Amir Mari, Tawfik Khoury, Haim Shirin, Efrat Broide
Timna Naftali, Institute of Gastroenterology, Meir Medical Center, Kfar-saba 4428164, Israel
Vered Richter, Department of Gastroenterology, Shamir Medical Center, Zerifin 70300, Israel
Amir Mari, Tawfik Khoury, Department of Gastroenterology, Nazareth Hospital, Nazareth 16100, Israel
Haim Shirin, Shamir (Assaf Harofeh) Medical Center, Affiliated to Sackler School of Medicine, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Tel Aviv University, Zerifin 70300, Israel
Efrat Broide, Pediatric Gastroenterology Unit, Asaf Harofeh Medical Center, Zrifin 70300, Israel
Author contributions: Naftali T, Richter V, Mari A, Khoury T, Shirin H, and Broide E designed and coordinated the study; Naftali T, Richter V, Mari A, Khoury T, Shirin H, and Broide E performed the experiments, acquired and analyzed data; Naftali T, Richter V, Shirin H, and Broide E interpreted the data; Naftali T, Richter V, Shirin H, and Broide E wrote the manuscript; all authors approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by Shamir Medical Center Institutional Review Board, Approval No. 0097-20-ASF.
Informed consent statement: Informed consent was waived because the questionnaire was answered anonymously and responding to the questionnaire was considered consent
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vered Richter, MD, Doctor, Department of Gastroenterology, Shamir Medical Center, Beer Yaakov, Zerifin 70300, Israel. veredr@shamir.gov.il
Received: March 8, 2022
Peer-review started: March 8, 2022
First decision: April 5, 2022
Revised: May 5, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

Inflammatory bowel disease (IBD) patients’ expectations of treatment outcomes may differ by ethnicity.

AIM

To investigate treatment preferences of Jewish and Arabs patients.

METHODS

This prospective survey ranked outcomes treatment preferences among Arab IBD patients, based on the 10 IBD-disk items compared to historical data of Jews. An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients. Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals. Answers were compared to the answers of a historical group of Jewish patients.

RESULTS

IBD-disk items of 121 Arabs were compared to 240 Jewish patients. The Jewish patients included more females, [151 (62.9%) vs 52 (43.3%); P < 0.001], higher education level (P = 0.02), more urban residence [188 (78.3%) vs 54 (45.4%); P < 0.001], less unemployment [52 (21.7%) vs 41 (33.9%); P = 0.012], higher income level (P < 0.001), and more in a partnership [162 (67.8%) vs 55 (45.4%); P < 0.001]. Expectations regarding disease symptoms: abdominal pain, energy, and regular defecation ranked highest for both groups. Arabs gave significantly lower rankings (range 4.29–6.69) than Jewish patients (range 6.25–9.03) regarding all items, except for body image. Compared to Arab women, Jewish women attached higher priority to abdominal pain, energy, education/work, sleep, and joint pain. Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity (OR 4.77; 95%CI 2.36–9.61, P < 0.001) and disease activity. The more active the disease, the greater the odds ratio for higher ranking of the questionnaire items (1-2 attacks per year: OR 2.13; 95%CI 1.02–4.45, P = 0.043; and primarily active disease: OR 5.29; 95%CI 2.30–12.18, P < 0.001). Factors inversely associated with higher patient preference were male gender (OR 0.5; 95%CI 0.271-0.935, P = 0.030), UC (OR 0.444; 95%CI 0.241–0.819, P = 0.009), and above average income level (OR 0.267; 95%CI: 0.124–0.577, P = 0.001).

CONCLUSION

The highest priority for treatment outcomes was symptom relief. Patients preferences were impacted by ethnicity, gender, and socio-economic disparity. Understanding patients' priorities may improve communication and enable a personalized approach.

Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Patients’ preferences, Ethnicity, IBD-disk, Patients reported outcomes

Core Tip: This prospective survey ranked preferences of treatment outcomes among Arab and Jewish inflammatory bowel disease (IBD) patients, based on the 10 IBD-disk items. Symptom relief was the highest priority in both groups. Ethnicity, gender, and socioeconomic disparity impact patients' rankings priorities for treatment outcomes. Arabs gave significantly lower rankings than Jewish patients regarding all items, except for body image. Jewish women, compared to Arabs, attached higher priority to abdominal pain, energy, education/work, sleep, and joint pain. Multivariable regression analysis revealed that higher patient preferences were associated with Jewish religion and disease activity.