N19 Analysis of Decision Conflict and Decisional Regret on treatment choices in patients with Acute Severe Ulcerative Colitis
J Mcbride, M Thomas, A L Fitzgerald, H Robertson, J Turnbull, A Talbot, J Thut, E Whitehead, S SebastianAbstract
Background
Informed choice about treatment options in the setting of Acute Severe Ulcerative Colitis (ASUC) is often challenging for the patient due to state of heightened stress in this acute setting and the ongoing uncertainties about treatment outcomes, it is uncertain whether patients reconcile with their choice made in this acute setting. We aimed to evaluate decisional conflict and decisional regret among ASUC patients and examine whether decisional conflict contributed to regret.
Methods
Patients included in a prospective observational study of ASUC filled two psychometric instruments Decisional Conflict Scale (DCS) and Decisional Regret Scale (DRS). Patients were followed up for 12 months. Differences in DCS scores between patients who underwent colectomy versus those treated with medical therapy were evaluated. Changes in DRS scores at follow up was analysed and factors resulting in high decisional regret scores were evaluated.
Results
Of the 219 patients admitted with ASUC 87 completed the DRS at 12 months. Of these, 70 had no regrets about their treatment, 11 were neutral, and 6 regretted their decision fig1. Among patients who underwent colectomy, 12 patients completed the DCS at 90 days, with 8 agreeing that it was the right decision by 12 months. For biologic treatment, 70 patients completed the DCS at 90 days, with 63 agreeing it was the right choice, and 44 patients completed the DCS at 12 months, with 43 agreeing. A subgroup of 36 patients who were unsure about their treatment choice at 90 days showed a more divided response, with 17 agreeing it was the right choice by 12 months, while 11 remained uncertain.
Conclusion
This study highlights the psychological challenges faced by ASUC patients in their treatment decisions. Decisional conflict is highly prevalent, particularly among those uncertain about their treatment options. These findings suggest the need for developing tailored decision aid tools to facilitate improved shared decision-making processes in ASUC.