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Master of Public Health

Complex Patient Perspectives on Evolving Diverticulitis Treatment

AUTHORS

Altman-Merino A , Bonnet K , Schlundt D , Wrenn J , Self WH , Gordon EJ , Hawkins AT , . medRxiv : the preprint server for health sciences. 2023 6 27; ().

ABSTRACT

BACKGROUND: Despite evidence that antibiotics may not be necessary to treat acute uncomplicated diverticulitis, they remain the mainstay of treatment in the United States. A randomized controlled trial evaluating antibiotic effectiveness could accelerate implementation of an antibiotic-free treatment strategy, but patients may be unwilling to participate.

OBJECTIVE: This study aims to assess patients’ attitudes regarding participation in a randomized trial of antibiotics versus placebo for acute diverticulitis, including willingness to participate.

DESIGN: This is a mixed-methods study with qualitative and descriptive methods.

SETTINGS: Interviews were conducted in a quaternary care emergency department and surveys were administered virtually through a web-based portal.

PATIENTS: Patients with either current or previous acute uncomplicated diverticulitis participated.

INTERVENTIONS: Patients underwent semi-structured interviews or completed a web-based survey.

MAIN OUTCOME MEASURES: Rates of willingness to participate in a randomized controlled trial was measured. Salient factors related to healthcare decision-making were also identified and analyzed.

RESULTS: Thirteen patients completed an interview. Reasons to participate included a desire to help others or contribute to scientific knowledge. Doubts about the efficacy of observation as a treatment method were the main barrier to participation. In a survey of 218 subjects, 62% of respondents reported willingness to participate in a randomized clinical trial. “What my doctor thinks,” followed by “What I’ve experienced in the past” were the most important decision-making factors.

LIMITATIONS: There is possible selection bias inherent to using a study to evaluate willingness to participate in a study. Also, the population sampled was disproportionately White compared to the population affected by diverticulitis.

CONCLUSIONS: Patients with acute uncomplicated diverticulitis maintain complex and varying perceptions of the use of antibiotics. Most surveyed patients would be willing to participate in a trial of antibiotics versus placebo. Our findings support a trial’s feasibility and facilitate an informed approach to recruitment and consent.

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