Does doctors' knowledge of inflammatory bowel disease patients' psychological status affect patients' clinical outcomes: a pilot randomized controlled trial

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We have carried out a pilot randomized controlled trial on the relationship between doctors' knowledge of inflammatory bowel disease (IBD) patients' psychological status and patients' clinical outcomes. On the basis of the biopsychosocial paradigm [1], we conceptualized that if gastroenterologists had improved knowledge of their patients' psychological status, they may be more likely to discuss psychological difficulties with their patients and connect with them on a more personal level. This, in turn, could improve patients' mental health and medication compliance and thus lead to better outcomes. Interestingly, it has been shown elsewhere that a good therapeutic relationship can significantly improve medication compliance in patients with IBD [2].
Out of 64 IBD patients who agreed to participate in a larger study (over an enrolment period of 7 months), 25 fulfilled the eligibility criteria for this substudy wherein the psychological status of half the group was revealed to their treating clinician (anxiety and/or depression detected by the Hospital Anxiety and Depression Scale [3]). Over the ensuing year, physical and psychological measures were made thrice monthly. Patients' baseline characteristics are presented in Table 1. Neither significant differences on any of the variables shown, nor did the groups differ in age or disease duration. However, there was a tendency towards greater anxiety at baseline in the disclosure group [t(23)=2, P=0.056].
During the 12-month trial period, six doctors' interventions concerning psychological issues were identified. Interventions occurred in five patients (38%) from the disclosure group and in only one (9%) from the control group. The difference between the groups, however, was not statistically significant (Fisher's exact test P=0.166), most likely because of the small sample size. Moreover, over time, there was no statistically significant difference between the groups in anxiety, depression or disease activity. Interestingly, the interventions included: advice to see a psychiatrist, advice to talk with a patient's general practitioner about treatment with antidepressants, talk and counselling about stress, discussing the Hospital Anxiety and Depression Scale results sent to the doctor by the researcher, talk about anxiety and prescribing an antidepressant. Antidepressants were prescribed in three patients with a good effect on sleep, mood disorders and general well being in each case.
Although statistically the results of our small trial are inconclusive, we believe that the suggestion that doctors' behaviour was indeed modified by disclosure of their patients' psychological status is an important finding. The numerical difference of five psychological interventions in the disclosure group versus only one in the control group suggests that this sort of approach prompts doctors to act when psychological comorbidities are identified. It is important to explore this type of intervention further as, if successful, it may improve management of IBD patients. Clearly with this preliminary finding, larger studies of this type are warranted.

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