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Wilkin K, Evans S, Van Niekerk L, Romano D, Fuller-Tyszkiewicz M, Knowles S, Chesterman S, Raven L, Mikocka-Walus A. Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation. J Clin Psychol Med Settings 2024; 31:245-257. [PMID: 38347385 PMCID: PMC11102374 DOI: 10.1007/s10880-023-09999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 05/20/2024]
Abstract
The current study explored perspectives of those with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression on a hybrid acceptance and committment therapy (ACT) intervention, compared to an active control. This qualitative study was nested within a randomized controlled trial (RCT) where an experimental group received an 8-week blended delivery ACTforIBD intervention (four sessions telehealth, four sessions pre-recorded self-directed), while an active control group received a psychoeducation program of similar intensity. Semi-structured interviews were conducted post-intervention and at a 3-month follow-up. Themes were interpreted using reflexive thematic analysis. Twenty individuals participated; ten in each condition. Seven themes were constructed, including three shared themes between groups: I Am Worth Advocating For, Present Moment Is My Biggest Ally, and Ambivalence About Self-Directed Modules. Two themes were identified for the ACTforIBD group: Symptoms Are Going to Happen and Moving Toward Values while two themes identified from the ActiveControl group were: Reset and Refresh and It's Ok to Say No. Acceptance and values modules from ACTforIBD were perceived as useful in reducing psychological distress for those with IBD, while the ActiveControl group felt their program affirmed existing effective coping strategies. Access to external resources for self-directed modules and networking may increase engagement with content long term.
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Affiliation(s)
- Kathryn Wilkin
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, University of Tasmania, Churchill Avenue, Sandy Bay, Hobart, TAS, Australia
| | - Daniel Romano
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | | | - Simon Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan Chesterman
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leanne Raven
- Crohn's & Colitis Australia, Melbourne, VIC, Australia
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Lores T, Mikocka-Walus A, Andrews JM, Evans S, Lynch KD, Chur-Hansen A. Psychological Care for People with Inflammatory Bowel Diseases: Exploring Consumers' Perspectives to Inform Future Service Co-design. Dig Dis Sci 2024; 69:1979-1989. [PMID: 38637459 PMCID: PMC11162373 DOI: 10.1007/s10620-024-08377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/03/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There is a need to improve psychological care for people with Inflammatory Bowel Diseases (IBD), noting the high psychosocial burden of disease. AIMS This study qualitatively explored the views of people living with IBD to help inform future co-design of services that better meet the psychological needs of consumers. METHODS Adults with IBD were recruited to attend virtual focus groups to discuss what they want most in an IBD-specific psychological service. The discussions were recorded and transcribed, and data were analyzed using conventional qualitative content analysis. Draft results were summarized midway and reviewed by remaining focus groups and a final expert consumer. A quantitative dataset was created of comment frequencies. RESULTS Thirty-one participants took part in the study: 10 focus groups were held with an average of three participants per group. The analysis identified 254 codes, 38 sub-categories and six categories. Five main categories were identified for an IBD-specific psychological service: People-Centered Healthcare (commented on by 90% of participants), Education and Preparation (83%), Social Connection (83%), Psychological Input (93%), and Accessible Services (97%). Results were summarized in a set of proposed clinical guidelines. CONCLUSIONS The findings of this study identify important insights from people living with IBD regarding priorities for psychological services. IBD services should focus on improving education, addressing social connection, and integrating psychological input, as well as becoming more people-centered and accessible. It is hoped that IBD services consult the proposed clinical guidelines to inform co-designed service improvements.
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Affiliation(s)
- Taryn Lores
- Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
- Royal Adelaide Hospital, Central Adelaide Local Health Network (CALHN), Port Road, Adelaide, SA, 5000, Australia.
- Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | | | - Jane M Andrews
- Royal Adelaide Hospital, Central Adelaide Local Health Network (CALHN), Port Road, Adelaide, SA, 5000, Australia
| | - Subhadra Evans
- Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kate D Lynch
- Royal Adelaide Hospital, Central Adelaide Local Health Network (CALHN), Port Road, Adelaide, SA, 5000, Australia
| | - Anna Chur-Hansen
- Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
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3
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Miglioretto C, Beck E, Lambert K. What do people with inflammatory bowel disease want to know about diet? The dietary information needs of people with inflammatory bowel disease and perceptions of healthcare providers. J Hum Nutr Diet 2024; 37:706-716. [PMID: 38462982 DOI: 10.1111/jhn.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an incurable illness of the gastrointestinal tract. Its relapsing-remitting nature negatively impacts physical health and quality of life. Food and eating are key concerns for people with this illness. To provide holistic person-centred care, healthcare providers (HCPs) need to meet patients' dietary information needs. However, there is a paucity of literature describing these in any meaningful detail. The present study aimed to explore the perceived dietary information needs of individuals with IBD, the perceptions of HCPs and enablers and barriers to communication. METHODS Online and face-to-face semi-structured interviews with 13 HCPs and 29 people with IBD were conducted. The framework method aided thematic analysis of de-identified interview recordings. RESULTS The cyclical nature of IBD contextualised the five themes. Both individuals with IBD and HCPs articulated similar ideas viewed from different perspectives: (1) living with IBD is exasperating and unique to the individual; (2) individuals with IBD desire dietary information; (3) diet manipulation is used to exert control on a disease with unpredictable nature; (4) people with IBD and HCPs have different views on the role of diet; and (5) doctors are perceived as gatekeepers to accessing dietetics care. CONCLUSIONS A lack of dietary guidance at diagnosis negatively impacts the patient's journey with food and eating. The present study supports a paradigm shift towards holistic person-centred care for consistent access to dietetics services to meet the needs of people with IBD.
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Affiliation(s)
- Chiara Miglioretto
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Eleanor Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- School of Health Sciences, University of New South Wales, Kensington, NSW, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
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Miglioretto C, Beck E, Lambert K. A scoping review of the dietary information needs of people with inflammatory bowel disease. Nutr Diet 2024; 81:79-93. [PMID: 37806663 DOI: 10.1111/1747-0080.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIMS This review aimed to explore and describe the dietary information needs of individuals with inflammatory bowel disease and sources of information. METHODS A scoping review of English language articles and grey literature, using electronic databases with a predefined search strategy was undertaken. Data were synthesised based on the identified variables (e.g. dietary information needs and sources of dietary information) corresponding to the aims of this review. RESULTS Forty-six studies were included, reporting data from 7557 people with inflammatory bowel disease, of which 58.6% had Crohn's disease and 60.1% were males. Dietary information was rated very important and appeared to be influenced by the disease course. The need to discuss it is heightened at important stages, namely diagnosis and relapse. Dietary information was described broadly and included advice about foods to avoid and dietary advice for symptoms management. No major differences were noted in the dietary information needs of people with Crohn's disease compared to ulcerative colitis. The main sources of dietary information were the gastroenterologist (36%-98%), the internet (9%-60%) and non-dietetic professionals (84.7%). CONCLUSION This review highlights limited literature describing the dietary information needs of people with inflammatory bowel disease. Importantly, the limited access to specialised dietary advice for this cohort is concerning. Future studies are required to explore not only the nuances in the needs of those with active disease and in remission, but to further understand issues of access to specialised dietary advice to provide holistic person-centred care desired by this cohort.
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Affiliation(s)
- Chiara Miglioretto
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Eleanor Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Vernon‐Roberts A, Chan P, Christensen B, Day AS, Havrlant R, Giles E, Williams A. Transitional care of adolescents with inflammatory bowel disease to adult services varies widely across Australia and New Zealand. JGH Open 2024; 8:e13032. [PMID: 38268957 PMCID: PMC10805482 DOI: 10.1002/jgh3.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim Children and adolescents account for approximately 14% of inflammatory bowel disease (IBD) diagnoses. At an appropriate age and level of development adolescents with IBD have their care transferred from the pediatric to adult clinical team during a process termed "transition". The study aim was to survey pediatric gastroenterologists throughout Australasia to identify commonality in the transition process to contribute to standardized guideline development. Methods A descriptive survey captured key variables: transition clinic format, process and infrastructure, transition assessments, and guidelines. The survey was distributed electronically to 59 Pediatric Gastroenterologists throughout Australasia in January 2023. Results Seventeen (29%) clinicians completed the survey: Australia 13 (76%). New Zealand 4 (24%). Thirteen (76%) respondents had access to a dedicated IBD transition clinic. Adolescents attended transition clinics 1-7 times, and the main processes transferred were: prescription provision, biologic appointments, and adult team contacts. Transition was first discussed age 13-15 years (53%), or 16-18 years (47%), with the main discussion topics including: continuing adherence (88%), smoking (59%), alcohol use (59%), recreational drug use (59%). Transition readiness assessments were done infrequently (24%). The minority (24%) used formal guidelines to inform the transition process, but 15 (88%) considered the development of a standardized Australasian guideline as beneficial/extremely beneficial. Conclusions This survey highlighted that transition care for adolescents with IBD is variable across Australasia. Australasian guideline development may optimize the transition process for adolescents with IBD and improve their longitudinal outcomes.
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Affiliation(s)
| | - Patrick Chan
- Department of GastroenterologyLiverpool HospitalSydneyAustralia
| | - Britt Christensen
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Andrew S Day
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | | | - Edward Giles
- Department of PaediatricsMonash Children's HospitalMelbourneAustralia
| | - Astrid‐Jane Williams
- Department of GastroenterologyLiverpool HospitalSydneyAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesAustralia
- Ingham Institute for Applied Medical ResearchSydneyAustralia
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McCarthy NE, Schultz M, Wall CL. Current state of dietetic services for inflammatory bowel disease patients in New Zealand: an observational study. Nutr Diet 2023; 80:538-545. [PMID: 37056216 DOI: 10.1111/1747-0080.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
AIM Nutritional therapies for inflammatory bowel disease are increasingly recommended. This study aimed to gain insight from patients, dietitians and gastroenterologists into inflammatory bowel disease dietetic care in New Zealand. METHODS Mixed-methods surveys were developed and then distributed online to patients with inflammatory bowel disease and dietitians and gastroenterologists that care for patients with inflammatory bowel disease. Quantitative survey data were analysed using nonparametric statistical tests. Qualitative survey data were analysed using thematic analysis. RESULTS Responses were received from 406 inflammatory bowel disease patients, 79 dietitians and 40 gastroenterologists. Half of the patients (52%) had seen a dietitian for nutrition advice. Patients more likely to have seen a dietitian were/had: Crohn's disease (p = 0.001), previous bowel surgery (p < 0.001), younger (p < 0.001) or receiving biologic therapy (p = 0.005). Two-thirds (66%) of patients found the dietitian advice at least moderately useful. A common theme from patient comments was that dietitians needed better knowledge of inflammatory bowel disease. Almost all (97%) gastroenterologists reported that their inflammatory bowel disease patients ask about nutrition; 57% reported that there were inadequate dietitians to meet patient needs. Over 50% of dietitians saw inflammatory bowel disease patients infrequently and 39% were not confident that their knowledge of the nutritional management of inflammatory bowel disease was current. Dietitians desired greater links with the inflammatory bowel disease multidisciplinary team. CONCLUSION Current inflammatory bowel disease dietetic services in New Zealand are inadequate. Standardised care, increased resourcing, dietitian training in inflammatory bowel disease, and stronger links with the multidisciplinary team are suggested to improve services.
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Affiliation(s)
- Nicky E McCarthy
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine L Wall
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Gravina AG, Pellegrino R, Durante T, Palladino G, D'Onofrio R, Mammone S, Arboretto G, Auletta S, Imperio G, Ventura A, Romeo M, Federico A. Telemedicine in inflammatory bowel diseases: A new brick in the medicine of the future? World J Methodol 2023; 13:194-209. [PMID: 37771865 PMCID: PMC10523254 DOI: 10.5662/wjm.v13.i4.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 09/20/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic digestive disease that requires continuous monitoring by healthcare professionals to determine the appropriate therapy and monitor short-term and long-term complications. The progressive development of information technology has enabled healthcare personnel to deliver care services to patients remotely. Therefore, various applications of telemedicine in IBD management have evolved, including telemonitoring, teleconsulting, teleducation, telenursing, telenutrition, and telepathology. While evidence has been provided for some telemedicine applications, targeted studies are still required. This review summarises the major studies that have evaluated telemedicine and its application in the management of IBD.
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Affiliation(s)
| | - Raffaele Pellegrino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Tommaso Durante
- Mental Health Department, “S. Pio” Hospital, Benevento 82100, Italy
| | - Giovanna Palladino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Rossella D'Onofrio
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Simone Mammone
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Giusi Arboretto
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Salvatore Auletta
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Giuseppe Imperio
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Andrea Ventura
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Mario Romeo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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8
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Elford AT, Leong RW, Halmos EP, Morgan M, Kilpatrick K, Lewindon PJ, Gearry RB, Christensen B. IBD barriers across the continents: a continent-specific analysis - Australasia. Therap Adv Gastroenterol 2023; 16:17562848231197509. [PMID: 37701793 PMCID: PMC10493058 DOI: 10.1177/17562848231197509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs.
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Affiliation(s)
- Alexander T. Elford
- Royal Melbourne Hospital, Melbourne University, 300 Grattan Street, Melbourne, VIC 3050, Australia
| | - Rupert W. Leong
- Concord Repatriation Hospital, Sydney, NSW, Australia Macquarie University, Sydney, NSW, Australia
| | - Emma P. Halmos
- Alfred Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia
| | - Manal Morgan
- Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Kate Kilpatrick
- Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | - Peter J. Lewindon
- Queensland Children’s Hospital, Brisbane, QLD, Australia University of Queensland, Brisbane, QLD, Australia
| | - Richard B. Gearry
- Christchurch Hospital, Christchurch, Canterbury, New Zealand University of Otago, Christchurch, Canterbury, New Zealand
| | - Britt Christensen
- Royal Melbourne Hospital, Melbourne, VIC, Australia Melbourne University, Melbourne, VIC, Australia
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9
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Mathias H, Rohatinsky N, Murthy SK, Novak K, Kuenzig ME, Nguyen GC, Fowler S, Benchimol EI, Coward S, Kaplan GG, Windsor JW, Bernstein CN, Targownik LE, Peña-Sánchez JN, Lee K, Ghandeharian S, Jannati N, Weinstein J, Khan R, Im JHB, Matthews P, Davis T, Goddard Q, Gorospe J, Latos K, Louis M, Balche N, Dobranowski P, Patel A, Porter LJ, Porter RM, Bitton A, Jones JL. The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care. J Can Assoc Gastroenterol 2023; 6:S111-S121. [PMID: 37674496 PMCID: PMC10478809 DOI: 10.1093/jcag/gwad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai IBD Centre of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sharyle Fowler
- Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Latos
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Naji Balche
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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10
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Karimi N, Moore AR, Lukin A, Connor SJ. Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review. CROHN'S & COLITIS 360 2023; 5:otad021. [PMID: 37162798 PMCID: PMC10164291 DOI: 10.1093/crocol/otad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 05/11/2023] Open
Abstract
Background In the absence of targeted empirical evidence on effective clinical communication in inflammatory bowel disease (IBD), a broad overview of existing evidence on effective communication in healthcare and available recommendations for communication in telehealth is provided and mapped onto IBD research and practice. Methods A narrative literature review was conducted using Pubmed and Scopus databases and snowballing literature search. Results Evidence-based relationship building strategies include communicating emotions, acknowledging and addressing patients' hesitancy, and ensuring continued support. A particular recommendation regarding telehealth interaction is to avoid long stretches of talk. Effective informational strategies include facilitating and supporting information exchange and considering patients' preferences in decision-making. In teleconsultations, clinicians should ask direct questions about patients' emotional state, clarify their understanding of patients' concerns and check patients' understanding, address at least one patient-reported outcome when discussing the recommended treatment, and shorten the consultation where possible. Strategies for maximizing effective clinical communication in the spoken communicative mode include using infographics and simple language, and assessing adherence at the beginning of the consultation. For teleconsultations, clinicians are advised to allow patients to explain the reason for their call at the beginning of the teleconsultation, probe additional concerns early and before ending the teleconsultation, and be mindful of technical issues such as voice delays. Conclusions Use of question prompt lists, decision aids, micro-lessons, and communication training interventions for clinicians could be beneficial in IBD care. Further research into the implementation of such interventions as well as clinical communication concerns specific to IBD is warranted.
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Affiliation(s)
- Neda Karimi
- Address correspondence to: Neda Karimi, PhD, 1 Campbell Street, Liverpool, NSW 2170, Australia ()
| | | | - Annabelle Lukin
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Susan J Connor
- South Western Sydney Inflammatory Bowel Disease Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
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11
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Naude C, Skvarc D, Knowles S, Russell L, Evans S, Mikocka-Walus A. The effectiveness of mindfulness-based interventions in inflammatory bowel disease: A Systematic Review & Meta-Analysis. J Psychosom Res 2023; 169:111232. [PMID: 36990003 DOI: 10.1016/j.jpsychores.2023.111232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Mental health has been identified as contributing to the pathogenesis of Inflammatory Bowel Disease (IBD). Resultingly, psychotherapeutic interventions, such as Mindfulness-Based Interventions (MBI), have been increasingly investigated for improving IBD outcomes. OBJECTIVES To systematically review the current state of evidence of MBI's for individuals living with IBD. METHODS We performed a systematic review searching Medline, PsychINFO, CINAHL, Embase, Cochrane and Scopus, to identify controlled clinical trials, investigating MBI's for various IBD biopsychosocial outcomes. Data was pooled using the inverse-variance random effects model, with restricted maximum likelihood estimation, providing the standardized mean difference (SMD) between control and experimental groups, at both short and long-term follow up. RESULTS We identified 8 studies with 575 participants. Meta-analytic results found that MBI's were more efficacious than control groups in the short-term improvement of stress (SMD = -0.38, 95% CI [-0.65, -0.10], p = 0.007), mindfulness (SMD = 0.59, 95% CI [0.36, 0.83], p = 0.00001), C-Reactive Protein (CRP) (SMD = -0.25, 95% CI [-0.49, -0.01], p = 0.04) and health-related quality of life (HRQoL) (SMD = 0.45, 95% CI [0.24, 0.66], p = 0.0001) (including all emotional, bowel, social and systemic subscales). This was maintained in the long-term for stress (SMD = -0.44, 95% CI [-0.88, -0.01], p < 0.05) and mindfulness (SMD = 0.52, 95% CI [0.14, 0.90], p = 0.008), but not for HRQoL, with no long-term data available for CRP. CONCLUSIONS Given that MBI's appear to be effective in improving several IBD outcomes, they may be a useful adjuvant therapy in wholistic IBD care, with further trials warranted.
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Affiliation(s)
- Colette Naude
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia.
| | - David Skvarc
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia
| | - Simon Knowles
- Department of Psychology, Swinburne University of Technology, VIC, Australia
| | - Lahiru Russell
- Faculty of Health, Institute for Health Transformation, Deakin University Geelong, Melbourne, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University Geelong, Melbourne, VIC, Australia
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12
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Lores T, Krishnaprasad K, Connor SJ, Cabaero A, Andrews JM. Integration of mental health and quality of life screening tools in an inflammatory bowel disease-specific electronic medical record (Crohn Colitis Care): process and early outcomes. Intern Med J 2023; 53:136-139. [PMID: 36693645 DOI: 10.1111/imj.15989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 01/26/2023]
Abstract
Psychological problems are prevalent in people with inflammatory bowel diseases but are not routinely addressed. To improve recognition, three psychological screening tools were integrated into clinical management software (Crohn Colitis Care). In the first 6 months, completion rates varied between participating sites, and approximately 23-34% of respondents scored in moderate or higher ranges for psychological distress. Evaluation of the clinical utility of the module to improve patient outcomes is recommended.
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Affiliation(s)
- Taryn Lores
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Krupa Krishnaprasad
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan J Connor
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia.,South West Sydney Clinical Campuses, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Aura Cabaero
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jane M Andrews
- Gastroenterology, General and Gastrointestinal Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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13
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Heisler C, Rohatinsky N, Mirza RM, Kits O, Zelinsky S, Veldhuyzen van Zanten S, Nguyen G, McCurdy J, MacMillan M, Lakatos PL, Targownik L, Fowler S, Rioux K, Jones J. Patient-Centered Access to IBD Care: A Qualitative Study. CROHN'S & COLITIS 360 2022; 5:otac045. [PMID: 36777367 PMCID: PMC9825304 DOI: 10.1093/crocol/otac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Canada has the highest global age-adjusted incidence and prevalence rates of inflammatory bowel disease (IBD). Due to IBD patient volumes and limited resources, challenges to timely access to specialty care have emerged. To address this gap, the aim of this paper was to understand the experiences and perspectives of persons living with IBD with a focus on accessing health care. Methods Using a qualitative descriptive approach, patients diagnosed with IBD (≥18 years of age) were purposively sampled from rural and urban gastroenterology clinics and communities across Canada. Co-facilitated by a researcher and patient research partner, 14 focus groups were recorded, transcribed, and coded for themes. Thematic analysis was used to ascertain the congruence or discordance of IBD specialty care access experiences. Results A total of 63 individuals participated in the study. The majority of participants were female (41/63, 65%) and from urban/suburban regions (33/63, 52%), with a mean age of 48.39 (range 16-77 years). The analysis generated three main themes: (1) need for patient to be partner, (2) adapting IBD care access to individual context, and (3) patient-defined care priorities should guide access to IBD care. Conclusions The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the impact of these factors on accessing care. Using a patient-centered exploration of barriers and facilitators, IBD specialty care access in Canada can be better understood and improved on provincial and national levels.
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Affiliation(s)
- Courtney Heisler
- QEII Health Sciences Centre, Division of Digestive Care & Endoscopy, Halifax, Canada
| | - Noelle Rohatinsky
- QEII Health Sciences Centre, Division of Digestive Care & Endoscopy, Halifax, Canada
| | - Raza M Mirza
- University of Saskatchewan, College of Nursing, Saskatoon, Canada
| | - Olga Kits
- University of Toronto, Institute for Life Course and Aging, Toronto, Canada
| | - Sandra Zelinsky
- Dalhousie University, Research Methods Unit, Halifax, Canada
| | | | - Geoffrey Nguyen
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | | | | | | | - Laura Targownik
- University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
| | | | - Kevin Rioux
- University of Saskatchewan, Saskatoon, Canada
| | - Jennifer Jones
- Address correspondence to: Jennifer Jones, MD, MSc, FRCPC, Room 932 Victoria Building, QEII Health Sciences Center, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y5 ()
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14
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Fitzpatrick JA, Melton SL, Yao CK, Gibson PR, Halmos EP. Dietary management of adults with IBD - the emerging role of dietary therapy. Nat Rev Gastroenterol Hepatol 2022; 19:652-669. [PMID: 35577903 DOI: 10.1038/s41575-022-00619-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 02/08/2023]
Abstract
Historically, dietitians played a minor part in the management of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Patients were commonly referred for consequences of uncontrolled disease, such as malnutrition and bowel obstruction risk. Today, dietitians are fundamental members of the multidisciplinary IBD team, from educating on the role of diet at diagnosis and throughout the lifespan of a patient with IBD to guiding primary induction therapy. This aspect is reflected in published guidelines for IBD management, which previously placed diet as only a minor factor, but now have diet-specific publications. This Review describes a four-step approach in a dietitian's assessment and management of diet in patients with IBD: (1) identifying and correcting nutritional gaps and dietary imbalances; (2) considering diet to treat active disease with the use of exclusive enteral nutrition (EEN) or emerging diets that could replace EEN; (3) using therapeutic diets to control existing complications of IBD, such as reduced fibre to prevent bowel obstruction in stricturing disease or a fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet to manage co-existing functional gut symptoms; and (4) considering the role of diet in preventing IBD development in high-risk populations.
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Affiliation(s)
- Jessica A Fitzpatrick
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Sarah L Melton
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Chu Kion Yao
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Emma P Halmos
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
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15
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Feeney M, Chur-Hansen A, Mikocka-Walus A. People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis. J Clin Psychol Med Settings 2022; 29:570-577. [PMID: 34185254 DOI: 10.1007/s10880-021-09801-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients' access to proactive care.
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Affiliation(s)
- Meg Feeney
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia
| | - Anna Chur-Hansen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Antonina Mikocka-Walus
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia.
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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16
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Mikocka-Walus A, Lores T. Editorial: group-based hypnotherapy as good as individually delivered hypnotherapy for symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 2022; 56:158-159. [PMID: 35689321 DOI: 10.1111/apt.16947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Taryn Lores
- School of Psychology, Deakin University Geelong, Melbourne, Victoria, Australia.,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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17
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Melton SL, Fitzpatrick JA, Taylor KM, Halmos EP, Gibson PR. Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn's disease: a single-centre experience. Frontline Gastroenterol 2022; 14:6-12. [PMID: 36561792 PMCID: PMC9763639 DOI: 10.1136/flgastro-2022-102173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate clinical outcomes, patterns of use, tolerance and nutritional outcomes of exclusive enteral nutrition (EEN) in adults with Crohn's disease and to compare initiation in the inpatient compared with ambulatory care setting. DESIGN/METHOD Adults with Crohn's disease who received EEN at a single centre over 2.5 years were identified and outcomes assessed via examination of patient records. RESULTS EEN was initiated in 60 patients (23 as an outpatient) who had objective evidence of active disease. Of 49 in whom the goal was induction of remission, 28 completed EEN and 24 achieved clinical remission/response. Twenty-one withdrew prematurely, due to intolerance in 15 and disease factors in 6. Of 11 with a planned intervention, 6 fulfilled the goal of downstaging disease while two were intolerant. Completion of the prescribed therapy was associated with self-reported adherence to EEN and with improvements in disease activity scores and biochemical markers. Malnutrition halved (40% to 20%) and intentional weight loss (median 5.1 kg) was achieved in six obese patients. The major reason for intolerance was the inability to accept total avoidance of non-formula food. There were no differences in any outcomes according to the location of initiation of therapy. CONCLUSION Positive outcomes occur in 70% of adult patients with Crohn's disease tolerating EEN and 81% in those who are able to completely adhere to EEN, without compromise of nutritional status. Similar success occurs when initiated as an inpatient or outpatient. Failure to tolerate EEN is the major hurdle to its use.
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Affiliation(s)
- Sarah L Melton
- Gastroenterology, Monash University, Melbourne, Victoria, Australia,Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Jessica A Fitzpatrick
- Gastroenterology, Monash University, Melbourne, Victoria, Australia,Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Kirstin M Taylor
- Gastroenterology, Monash University, Melbourne, Victoria, Australia,Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Emma P Halmos
- Gastroenterology, Monash University, Melbourne, Victoria, Australia,Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Gastroenterology, Monash University, Melbourne, Victoria, Australia,Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
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18
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Evans S, Olive L, Dober M, Knowles S, Fuller-Tyszkiewicz M, O E, Gibson P, Raven L, Gearry R, McCombie A, van Niekerk L, Chesterman S, Romano D, Mikocka-Walus A. Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme. BMJ Open 2022; 12:e060272. [PMID: 35688593 PMCID: PMC9189839 DOI: 10.1136/bmjopen-2021-060272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD. METHODS AND ANALYSIS Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition. ETHICS AND DISSEMINATION This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences. TRIAL REGISTRATION NUMBER ACTRN12621001316897.
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Affiliation(s)
- Subhadra Evans
- Psychology, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Lisa Olive
- School of Pyschology, Deakin, Geelong, Victoria, Australia
| | - Madeleine Dober
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Simon Knowles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Eric O
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Peter Gibson
- Gastroenterology, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard Gearry
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Medicine, Christchurch, New Zealand
| | - Andrew McCombie
- Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leesa van Niekerk
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Daniel Romano
- School of Pyschology, Deakin, Geelong, Victoria, Australia
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19
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van Linschoten RCA, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, de Jonge V, Hazelzet JA, van der Woude CJ, West RL, van Noord D. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. BMJ Open 2022; 12:e050539. [PMID: 35022169 PMCID: PMC8756277 DOI: 10.1136/bmjopen-2021-050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Biologics are effective for the treatment of inflammatory bowel disease (IBD). However, unwarranted variation in processes and outcomes has been reported in the treatment of IBD. A care pathway for the treatment of IBD has the potential to reduce practice variation and improve outcomes. This study aims to compare the effect of a uniform care pathway for the treatment of patients with IBD with biologics to the current situation. METHODS AND ANALYSIS IBD Value is a longitudinal multicentre non-randomised parallel cluster trial with a baseline period. The study takes place in eight centres in the Netherlands. The baseline period will run for 12 months, after which the care pathway will be implemented in 6 of the 8 participating hospitals during the implementation phase of 3 months. Hereafter, the effect of the care pathway will be assessed for 12 months. Total study period is 27 months. The primary outcome is the effect of the care pathway on disease control (IBD-Control questionnaire). Secondary outcomes are the effect of the care pathway on the other outcomes of the International Consortium of Health Outcomes Measurement IBD standard set, health-related generic quality of life, patient experiences and degree of variation; cost effectiveness of the care pathway; and the variation between hospitals in the aforementioned outcomes in the baseline period. Outcomes will be measured every 6 months. The study started on 1 December 2020 and a minimum of 200 patients will be included. ETHICS AND DISSEMINATION The study was deemed not to be subject to Dutch law (WMO; Medical Research Involving Human Subjects Act) by the Medical Ethics Committee of the Erasmus MC, the Netherlands (registration number: MEC-2020-075) and a waiver was provided. Results will be disseminated through peer-reviewed journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NL8276.
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Affiliation(s)
- Reinier Cornelis Anthonius van Linschoten
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Genetics, University of Groningen, Groningen, The Netherlands
| | | | - Karen Evelyne Verweij
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Vincent de Jonge
- Department of Gastroenterology and Hepatology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | | | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rachel Louise West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
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20
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Prasad SS, Walker MM, Talley NJ, Keely S, Kairuz T, Jones MP, Duncanson K. Healthcare Needs and Perceptions of People Living With Inflammatory Bowel Disease in Australia: A Mixed-Methods Study. CROHN'S & COLITIS 360 2022; 4:otab084. [PMID: 36777548 PMCID: PMC9802190 DOI: 10.1093/crocol/otab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis are inflammatory bowel diseases (IBDs) that adversely affect the healthcare needs and quality of life (QoL) of people with IBD. The aim of this study was to explore the needs and perceptions of people with IBD in a primary care setting. Methods This sequential explanatory mixed-methods study consisted of a cross-sectional survey (included validated tools), followed by semistructured interviews on participants' perceptions: IBD management, healthcare professionals, IBD care, flare management, and pharmacist's IBD roles. Results Sixty-seven participants completed the survey, and 8 completed interviews. Quantitative findings: Age at diagnosis had significant association with medication nonadherence (P = .04), QoL (P = .04), and disease control (P = .01) among the respondents. The odds of medication nonadherence were 8 times (adjusted odds ratio [AOR] = 8.04, 95% confidence interval [CI] = 1.08, 60.10) higher among younger participants aged <30 years. Those diagnosed with CD (P = .02) reported more likely to have unfavorable perceptions of pharmacists' role in managing their IBD (AOR = 9.45, 95% CI = 1.57, 56.62) than those with UC and indeterminate colitis. Qualitative findings: General practitioners were considered the most important care provider and the first point of contact for patients in managing all aspects of IBD. Participants identified their key need to be timely access to specialized IBD care and found that other primary healthcare professionals lacked disease-specific knowledge for managing IBD. Conclusions Primary healthcare professionals are well positioned but need targeted training to influence the needs of IBD patients. The specialty role of an IBD educator could complement existing services to deliver and address patient-specific care.
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Affiliation(s)
- Sharmila S Prasad
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Marjorie M Walker
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Nicholas J Talley
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Therése Kairuz
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia
| | - Kerith Duncanson
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, New Lambton Heights, New South Wales, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
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21
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Lyall K, Beswick L, Evans S, Cummins RA, Mikocka-Walus A. Mindfulness Practice Is Associated With Subjective Wellbeing Homeostasis Resilience in People With Crohn's Disease but Not Ulcerative Colitis. Front Psychiatry 2022; 13:797701. [PMID: 35295784 PMCID: PMC8918514 DOI: 10.3389/fpsyt.2022.797701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES People with Crohn's disease and ulcerative colitis (inflammatory bowel disease: IBD), commonly experience high levels of depressive symptoms and stress and low levels of subjective wellbeing (SWB). Mindfulness is increasingly considered an adjuvant IBD treatment. The relationships between depression, disease symptoms and mindfulness have not previously been considered within the theory of SWB homeostasis. This theory states that SWB is normally maintained by a homeostatic system around a setpoint range but can fail when psychological challenges dominate consciousness. This study explored the relationship among SWB and patient-reported psychological and IBD symptoms and investigated whether mindfulness practice is independently associated with SWB homeostatic resilience. DESIGN This cross-sectional study recruited participants through online IBD support groups. METHODS Participants (n = 739; 62% Crohn's disease) detailed symptoms of depression and stress, patient-reported disease symptoms, and regularity of mindfulness practice. RESULTS The sample had significantly lower SWB (hedges g = -0.98) than normative data. A logistic regression found mindfulness practice doubled the Crohn's disease participants' odds of reporting SWB within the normal homeostatic range, after controlling for psychological, physical, and demographic variables (OR 2.15, 95% CI: 1.27, 3.66). A one-point increase of patient-reported bowel symptoms reduced the participant's odds of reporting SWB in the normal homeostatic range by about a third (OR 0.66, 95% CI: 0.50, 0.85). However, the influence of mindfulness or disease symptoms on SWB was not observed for people with ulcerative colitis. CONCLUSION These findings provide initial evidence for an association between mindfulness and SWB homeostatic resilience in a clinical population.
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Affiliation(s)
- Kimina Lyall
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Lauren Beswick
- Barwon Health, Department of Gastroenterology, Geelong, VIC, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Robert A Cummins
- School of Psychology, Deakin University, Melbourne, VIC, Australia
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Hawkins M, Massuger W, Cheng C, Batterham R, Moore GT, Knowles S, Nadarajah RG, Raven L, Osborne RH. Codesign and implementation of an equity-promoting national health literacy programme for people living with inflammatory bowel disease (IBD): a protocol for the application of the Optimising Health Literacy and Access (Ophelia) process. BMJ Open 2021; 11:e045059. [PMID: 34446478 PMCID: PMC8395357 DOI: 10.1136/bmjopen-2020-045059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Non-government organisations (NGOs) often represent people who are underserved or experiencing vulnerability. Crohn's & Colitis Australia (CCA) is aware that many Australians with inflammatory bowel disease (IBD) are not reached by current communication and engagement activities. The aim of the CCA IBD project is to implement the Optimising Health Literacy and Access (Ophelia) process over 3 years to collaboratively codesign ways to improve delivery of information, services and resources for people with IBD and their carers. METHODS AND ANALYSIS Health literacy and other data for phase 1 will be collected using the Health Literacy Questionnaire, eHealth Literacy Questionnaire, IBD-related questions and qualitative interviews with people with IBD and their carers to ascertain their lived experience. Quantitative data will be analysed using descriptive statistics and cluster analysis. Identified clusters will be combined with qualitative data to develop vignettes (narratives of people's experiences of living with IBD) for stakeholder workshops to generate ideas for useful, accessible and sustainable solutions for identified health literacy needs. Selection and testing of health literacy actions happens in phase 2 and implementation and evaluation in phase 3 (2021-2023). Outcomes of this project include giving voice to people living with IBD, their carers and frontline healthcare practitioners. Genuine codesign informs the development and implementation of what is needed and wanted to improve access to and availability and quality of information and resources that support people to manage their health. There is potential for other NGOs to use the CCA Ophelia model in other health contexts to improve engagement with and understanding of the needs of the people they serve and to reduce health inequalities and improve health outcomes. ETHICS AND DISSEMINATION Ethics approval for Ophelia phase 1 has been obtained from the Human Research Ethics Committee of Swinburne University of Technology (Ref: 20202968-4652) and by the South West Sydney Local Health District Research and Ethics Office for the purposes of questionnaire recruitment at Liverpool Hospital (Ref: 20202968-4652). Dissemination of the study findings will be the national codesign process and ownership development across the CCA community and through the genuine engagement of clinicians and relevant managers across Australia. The model and process will be directly distributed to international IBD associations and to other NGOs. It will also be disseminated through publication in a peer-reviewed journal, conference presentations and public reports on the CCA and Swinburne University of Technology website.
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Affiliation(s)
- Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Wayne Massuger
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University - Rangsit Campus, Khlong Nueng, Pathum Thani, Thailand
| | - Gregory T Moore
- Gastroenterology and Hepatology Unit, Monash Health, Clayton, Victoria, Australia
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Simon Knowles
- Department of Psychological Sciences and Statistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ranjit G Nadarajah
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Brenner EJ, Long MD, Mann CM, Lin L, Chen W, Reyes C, Bahnson KM, Reeve BB, Kappelman MD. Anxiety and Depressive Symptoms Are Not Associated With Future Pediatric Crohn's Disease Activity. Inflamm Bowel Dis 2021; 28:728-733. [PMID: 34245258 PMCID: PMC9071096 DOI: 10.1093/ibd/izab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Studies of adults with Crohn's disease (CD) suggest that poor mental health precedes worsening disease activity. We evaluated whether depression and/or anxiety forecast worsening pediatric CD disease activity. METHODS Through the Inflammatory Bowel Disease Partners Kids & Teens internet-based cohort, children with CD age 9 to 17 completed Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures and the short Crohn's disease activity index (sCDAI). Using general linear models, we examined how baseline PROMIS Pediatric anxiety and depressive symptom scores independently associate with subsequent sCDAI scores (average survey interval 6.4 months). Models included baseline PROMIS Pediatric anxiety and depressive symptoms scores, baseline sCDAI, sex, age, parental education, race/ethnicity, and prior IBD-related surgery. We performed a post hoc subanalysis of children in baseline remission (sCDAI <150) with otherwise identical models. RESULTS We analyzed 159 children with CD (mean age 14 years, 45% female, 84% in baseline remission). We found no association between baseline PROMIS Pediatric anxiety score and subsequent sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric -0.89; 95% CI -4.81 to 3.03). Baseline PROMIS Pediatric depressive symptoms score was not associated with future sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric <0.01; 95% CI -4.54 to 4.53). In a subanalysis of patients in remission at baseline, the lack of association remained. CONCLUSION We found that neither anxiety nor depressive symptoms associate with subsequent disease activity in pediatric CD. These findings contrast with adult IBD studies, thus underschoring the unique pathophysiology, natural history, and outcomes of pediatric CD.
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Affiliation(s)
- Erica J Brenner
- Department of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America,Address correspondence to: Erica J. Brenner, MD, University of North Carolina Department of Pediatric Gastroenterology, 333 S. Columbia St. 247 MacNider Hall, CB# 7229, Chapel Hill, NC, 27599, United States of America.
| | - Millie D Long
- Department of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Courtney M Mann
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Li Lin
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Wenli Chen
- Department of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Camila Reyes
- Office of Clinical Research, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Kirsten M Bahnson
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Bryce B Reeve
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Michael D Kappelman
- Department of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Pharmacists' Confidence in Managing Patients with Inflammatory Bowel Disease. PHARMACY 2020; 8:pharmacy8020068. [PMID: 32316504 PMCID: PMC7355482 DOI: 10.3390/pharmacy8020068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background and aim: Managing patients with a chronic condition such as inflammatory bowel disease (IBD), requires a multidiscipline approach. The pharmacist might be the first point of contact for patients with initial symptoms or relapsing flares, yet there is no available literature on the role of pharmacists in IBD management. We conducted a survey to explore pharmacists' confidence in and potential barriers to managing IBD and assess the impact of IBD education on their confidence in IBD management. Methods: Surveys assessing confidence levels in managing IBD, additional learning opportunities about IBD and barriers to their learning of IBD management were provided to pharmacists for completion before and after attending an IBD-specific education session at a national conference. Results: Of the 195 attendees, 125 participants completed the survey (64%). Most respondents reported a low to mid-range level of confidence with managing IBD. Specifically, they were only slightly confident in decision making on patient care, addressing patient needs and providing additional support for IBD patients; and somewhat confident with understanding, management and providing relevant information on IBD. Whist the education session improved pharmacists perceived level of confidence, most respondents indicated a need to learn more about IBD. Areas of additional learning included science, drug therapy, treatments (includes non-pharmacological options as well) and guidelines. A majority of pharmacists identified time constraints as a key barrier to learning. Conclusion: Pharmacists lack sufficient confidence about managing inflammatory bowel disease. These data indicate support within the pharmacy profession to play a more active role in the management of IBD.
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Mikocka-Walus A, Massuger W, Knowles SR, Moore GT, Buckton S, Connell W, Pavli P, Raven L, Andrews JM. Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes. JGH OPEN 2019; 4:166-171. [PMID: 32280760 PMCID: PMC7144796 DOI: 10.1002/jgh3.12236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 12/20/2022]
Abstract
Background and Aim Data on patient needs and access to psychological services in inflammatory bowel disease (IBD) are scarce. This study aimed to describe the levels of distress and the needs, attitudes, and access to psychological services for people within Australia against established Australian IBD Standards. Methods An online cross‐sectional survey was conducted with Australians ≥16 years old recruited via Crohn's & Colitis Australia membership, public and private clinics, and the Royal Flying Doctor Service. K10 was used to measure psychological distress. The Chi‐square test was used to compare those with and without distress on key variables. Results Overall, 731 respondents provided complete data (71.5% female, mean age 46.5 years). Overall, 50% of respondents reported distress; only 15.2% were currently seeing a mental health practitioner; only 16.1% were asked about their mental health by their IBD specialist or IBD nurse; and only 12.2% reported access to a mental health practitioner as part of their IBD service. Those with psychological distress were significantly less satisfied with their IBD care; more commonly hospitalized; had an active disease, fistula or perianal disease, pain, or fatigue; and were receiving steroids, opioids, or antidepressants (all P < 0.05). As many as 68.2% of those with severe distress were not seeing a mental health practitioner. Conclusions The integrated biopsychosocial model of health care, with regular mental health screening and good access to mental health professionals, is requested by people living with IBD to improve their outcomes.
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Affiliation(s)
| | - Wayne Massuger
- Crohn's & Colitis Australia Melbourne Victoria Australia
| | - Simon R Knowles
- School of Health Sciences Swinburne University of Technology Melbourne Victoria Australia
| | - Gregory T Moore
- Department of Gastroenterology Monash Medical Centre Melbourne Victoria Australia.,School of Clinical Sciences Monash University Melbourne Victoria Australia
| | - Stephanie Buckton
- Department of Gastroenterology Sunshine Coast University Hospital Sunshine Coast Queensland Australia
| | - William Connell
- Department of Gastroenterology St Vincent Hospital Melbourne Victoria Australia
| | - Paul Pavli
- Department of Gastroenterology Canberra Hospital Canberra Australian Capital Territory Australia
| | - Leanne Raven
- Crohn's & Colitis Australia Melbourne Victoria Australia.,Faculty of Science, Health and Engineering University of Sunshine Coast Sippy Downs Queensland Australia
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia Australia
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