Hi, I'm Kristen Colford. I'm the Executive Vice Chair in the Department of Medicine at the University of North Carolina. My clinical work, I'm an internist. I have my own practice and I work with both medical students and residents and I'm very interested in being here to help you today. Ilchen Inevsky, Gastroenterologist at Rockford, Gastroenterology Associates, Assistant Clinical Professor at the University of Illinois College of Medicine in Rockford. I've had some involvement in eosinophilic dysalphagitis since I was a fellow doing research. I continue to stay involved as much as I can and happy to be here as well. So this module, Module 11, is Shared Decision Making in Patients with EOE. And this is so critical. You know, we can have so much knowledge and science about what works in EOE, but if we can't really understand our patient's experience, understand the context in which they're living, the barriers, their preferences, we won't get them better. So I think it's really important to be able to review some of the basic foundations of shared decision making in general and then applying it to the specifics for patients who are navigating their experience and their symptoms and treatment with the EOE. Yeah, to build on that, I mean, everybody, we know now EOE is a chronic condition, so it requires long term solutions. And the way that we do that is by developing and building a, you know, a trusted provider patient relationship and shared decision making is critical. And most of us, perhaps some of us think that shared decision making is pretty straightforward, but there are some fundamental principles that we can embrace and take with us and use and implement on a daily basis to make it more impactful. I think, you know, when you look at the, go through the module, I really think that the, just the review of the components of shared decision making, I think it's something we learn in our, you know, in our professional schools when we're learning communication, but we can forget that there's, you know, simple components to shared decision making, making sure that you listen, actively ask questions and really understand the context in which your patient lives. And the module does really go over some of those really key components of shared decision making that sometimes we forget. So I think that's a really important part. To build on that, there's a case study that we use in the module that talks about a 17 year old male who will be an adult in about six months who has eosinophilic esophagitis. He's brought in by his parents. They are discussing, they want the best treatment, but they don't want any long-term medications. They don't want any dietary restrictions. They don't want any, they want things to be cost-effective. And part of the shared decision making journey is trying to understand where we as providers and patients, in terms of treatment of EOE, how we can do that, embracing all of those concerns and coming up with a solution that provides long-term relief, prevents long-term complications and gives the patient back their agency. I think if I, you know, as a trainer and using this, these materials, I think it's really in the context of EOE. I thought that there was a survey study that looked at patients with EOE and what factors influenced them with the choice of treatment. And it's not what the doctor says. It's, you know, really in the context of, you know, they want to feel better, they want to prevent complications, but they also want to really know and understand that this treatment will help them and that it works within their context of their lifestyle. So I thought that was really important to understand why it's so important in EOE in particular. To build on that, there was a study that looked at the kind of shared decision-making perceptions that patients had. And what it showed was that having connections with providers and specialists really do make a difference. And so making sure that the, that the patients know that this is a long-term connection. One of the things we discussed at our session yesterday was it's possible that in the quest to try to optimize therapy, it may require six endoscopies. And in that case, we have to try to explain how to do that and trying to use shared decision-making principles and explaining that why that's so important. One of the most important things when you're considering a chronic illness like EOE is really finding a treatment plan that your patient can, you know, complete. And so I always believe like there's no such thing as non-compliance. You know, I really believe if someone is non-compliant, it's because we didn't do a good enough job understanding the issues. You know, maybe the medication has a side effect or it's too expensive. So I just, you know, we have guidelines, we have best practices, and we want to explain those to patients, but we really need to understand, you know, how the patient is able to, you know, to live, you know, in the context of this illness. So I think, you know, in the module, it really does get back to you. In the case, it is a great example of, you know, if, if the patient really says, I don't, I can, there's no way I can do six endoscopies. That's a fact. We can't, you know, even though that really, you know, the data that you'll see in other modules shows it works to find those, you know, that dietary change that works for you. If that time in that patient's life, isn't allowing them to have every six or 12 week endoscopies, you help them bridge with a different, you know, treatment modality until maybe in the future they can do that. And I think that's the relationship you're trying to build with shared decision-making. So you have a long-term relationship that, you know, you can get there and maybe they'll get there in a few years that they're going to be able to do that dietary intervention that works, that they just have to avoid one food eventually. So I think it's just that it's, it's a long-term relationship and it's navigating how to keep that open conversation. And then I think the module really does kind of walk you through that with the case and some of the other areas. Yeah. And to build on that, I mean, using some of the key elements of shared decision-making, you can come up with an idea of looking at patients' preferences, patient values, the economics or socioeconomics, the understanding of compliance. What it does is it forces us to put ourselves in the patient's position. And by doing so, we'll be able to achieve, you know, the outcomes. Going back to the case, you know, if we're choosing food elimination as a potential, you know, you're asking a, you know, a young student that's going to be trying to fit in with friends and in certain social situations to create an absolute elimination. But there might be some times where you can go on a holiday and understand that it doesn't change and take us back to square one. So having those multiple visits with patients, allowing them to express their frustration where, why I can't eat wheat, I can't have pizza on Friday with my friends, why it's so important to try to come up with that. And then it also gives us an opportunity to say, this is a multiple, multidisciplinary condition where we can rely on allergists and we can rely on nutritionists, dietitians to give us guidance to help strengthen that provider-patient relationship. I think that the, you know, the module walks you through some of these basics of shared decision-making. And, you know, I think we always can use that, that refresher. And then I really like using that case to give your audience, you know, your learners the opportunity to share and to practice, you know, and to get that opportunity to sort of use either pulling examples from their own experiences of when, wow, it would have been helpful if I had used that particular area, you know, that particular topic or, you know, how they might apply it to the case in the module. So I think that allows some, this is really, I think, a module that if you can get some time to have that patient, that audience participation, it's going to make a big difference. I agree. I would consider starting with the case because it creates a great substrate to be able to build from and then go backwards towards the key elements and see where in your particular situation you might incorporate some of these key elements. This is a fluid type of module in the sense that you're not following things exactly. Well, now I'm going to talk about patient information sharing. I'm going to talk about preferences and values. It comes up organically or naturally in a discussion that you have with patients. And so having them available, using them as you need to create some more natural way of utilizing shared decision-making when you're actually in the real world taking care of patients. I hope that we'll be able to bring this information to you. I think it's really going to be a fun experience for you to bring these to your learners. I hope that you really enjoy the materials and have an engaging conversation and sessions that only improve your care of all of your patients, but in particular, your patients with EOE that you may be caring for now. Yeah, we hope you enjoy the module 11 in the grand scheme of the modules that we've helped create collectively for eosinophilic esophagitis. We'll provide a robust way for you to understand the condition and be able to deliver the best for your patients. The shared decision-making module is one of many that you can utilize, and we hope it provides you what you need to take care of your patients the best way you can.

eosinophilic esophagitis

treatment options

proton pump inhibitors

topical steroids

dupilumab

shared decision making

patient experiences

treatment plans

healthcare compliance

Patient Preferences

Provider-Patient Relationship