Multi-national observational study to assess quality of life and treatment preferences in patients with Crohn’s perianal fistulas

BACKGROUND Patients with Crohn’s disease(CD)are at risk of developing complications such as perianal fistulas.Patients with Crohn’s perianal fistulas(CPF)are affected by fecal incontinence(FI),bleeding,pain,swelling,and purulent perianal discharge,and METHODS This cross-sectional observational study was conducted in patients with CD aged 21-90 years via a web-enabled questionnaire in seven countries(April-August 2021).Patients were recruited into three cohorts:Cohort 1 included patients without perianal fistulas;cohort 2 included patients with perianal fistulas without fistula-related surgery;and cohort 3 included patients with perianal fistulas and fistula-related surgery.Validated patient-reported outcome measures were used to assess quality of life.Drivers of treatment preferences were measured using a discrete choice experiment(DCE).RESULTS In total,929 patients were recruited(cohort 1,n=620;cohort 2,n=174;cohort 3,n=135).Short Inflammatory Bowel Disease Questionnaire scores were worse for patients with CPF(cohorts 2 and 3)than for those with CD without CPF(cohort 1):Mean score 3.8 and 3.7 vs 4.1,respectively,(P<0.001).Similarly,mean Revised FI and FI Quality of Life scores were worse for patients with CPF than for those with CD without CPF.Quality of Life with Anal Fistula scores were similar in patients with CPF with or without CPF-related surgery(cohorts 2 and 3):Mean score 41 and 42,respectively.In the DCE,postoperative discomfort and fistula healing rate were the most important treatment attributes influencing treatment choice:Mean relative importance 35.7 and 24.7,respectively.CONCLUSION The burden of illness in CD is significantly higher for patients with CPF and patients rate lower postoperative discomfort and higher healing rates as the most desirable treatment attributes.

How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones?

Background:The impact of the coronavirus disease 2019(COVID-19)pandemic on patient decision making remains uncertain.This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones.Materials and methods:Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed.Data from 493 patients were analyzed according to 2 groups,including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic.Results:Preference for conservative treatment increased during the COVID-19 pandemic(p=0.009).In patients who had previously undergone shock wave lithotripsy(SWL),the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic(p=0.042).Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage(p=0.003;odds ratio[OR],2.48;95%confidence interval[CI],1.45-4.23),no hydronephrosis(p=0.035;OR,3.57;95%Cl,1.34-9.49),and a visual analog scale score of 4 or less(p=0.018;OR,1.97;95%Cl,1.15-3.38).Conclusions:A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic,and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.