Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management
Objective Many people with inflammatory bowel disease (IBD) experience fatigue, pain and faecal incontinence that some feel are inadequately addressed. It is unknown how many have potentially reversible medical issues underlying these symptoms.Methods We conducted a study testing the feasibility of...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/11/1/e001585.full |
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| author | Thomas Hamborg John McLaughlin Ailsa Hart Christine Norton Sonia Bouri Laura Miller Jean-Frédéric LeBlanc Asma Fikree Imogen Stagg Fionn Cléirigh Büttner |
| author_facet | Thomas Hamborg John McLaughlin Ailsa Hart Christine Norton Sonia Bouri Laura Miller Jean-Frédéric LeBlanc Asma Fikree Imogen Stagg Fionn Cléirigh Büttner |
| author_sort | Thomas Hamborg |
| collection | DOAJ |
| description | Objective Many people with inflammatory bowel disease (IBD) experience fatigue, pain and faecal incontinence that some feel are inadequately addressed. It is unknown how many have potentially reversible medical issues underlying these symptoms.Methods We conducted a study testing the feasibility of a patient-reported symptom checklist and nurse-administered management algorithm (‘Optimise’) to manage common medical causes of IBD-related fatigue, pain and faecal incontinence. We conducted qualitative interviews with nurses implementing the algorithm.Results 515 individuals reporting IBD-related symptoms were invited to participate, of whom 201 (39%) consented. 194/201 (97%) returned the symptom checklist, of whom 157 (81%) returned a postal faecal calprotectin sample. Five (3%) participants reported ‘red flags’ and 31/157 (20%) participants had a faecal calprotectin result ≥200 µg/g, of whom 12 (8%) were judged to have likely active inflammation when clinical symptoms and disease history were reviewed. The algorithm suggested at least one clinical test or intervention for fatigue, pain or faecal incontinence in 67 (43%) participants, of whom 25 (37%) declined. Among 87 participants for whom clinical actions were indicated, 57 (66%) completed follow-up outcomes 3 months after algorithm implementation. Three nurses interviewed found the Optimise algorithm easy to administer.Conclusion Implementing the Optimise checklist and algorithm appears feasible in UK clinical practice, with adjustments needed to minimise missing items. Not all patients accepted algorithm-indicated interventions, but a yield of 43% with symptoms having potentially reversible causes detected is clinically useful. Nurses endorsed ease and utility of the implementation process. Optimise now needs clinical effectiveness to be assessed. |
| format | Article |
| id | doaj-art-d8ca38c4de36410f993d9c47129f4eef |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-d8ca38c4de36410f993d9c47129f4eef2025-01-14T21:30:08ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742024-12-0111110.1136/bmjgast-2024-001585Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led managementThomas Hamborg0John McLaughlin1Ailsa Hart2Christine Norton3Sonia Bouri4Laura Miller5Jean-Frédéric LeBlanc6Asma Fikree7Imogen Stagg8Fionn Cléirigh Büttner9Queen Mary University of London, London, UKFaculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, The University of Manchester, Manchester, UKSt Mark`s Hospital and Academic Institute, London, UK1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King`s College London, London, UKWest Middlesex University Hospital NHS Trust, London, UKQueen Mary University of London, London, UKUniversity of Montreal, Montreal, Quebec, CanadaUniversity College Hospital, London, UKSt Mark`s Hospital and Academic Institute, London, UKQueen Mary University of London, London, UKObjective Many people with inflammatory bowel disease (IBD) experience fatigue, pain and faecal incontinence that some feel are inadequately addressed. It is unknown how many have potentially reversible medical issues underlying these symptoms.Methods We conducted a study testing the feasibility of a patient-reported symptom checklist and nurse-administered management algorithm (‘Optimise’) to manage common medical causes of IBD-related fatigue, pain and faecal incontinence. We conducted qualitative interviews with nurses implementing the algorithm.Results 515 individuals reporting IBD-related symptoms were invited to participate, of whom 201 (39%) consented. 194/201 (97%) returned the symptom checklist, of whom 157 (81%) returned a postal faecal calprotectin sample. Five (3%) participants reported ‘red flags’ and 31/157 (20%) participants had a faecal calprotectin result ≥200 µg/g, of whom 12 (8%) were judged to have likely active inflammation when clinical symptoms and disease history were reviewed. The algorithm suggested at least one clinical test or intervention for fatigue, pain or faecal incontinence in 67 (43%) participants, of whom 25 (37%) declined. Among 87 participants for whom clinical actions were indicated, 57 (66%) completed follow-up outcomes 3 months after algorithm implementation. Three nurses interviewed found the Optimise algorithm easy to administer.Conclusion Implementing the Optimise checklist and algorithm appears feasible in UK clinical practice, with adjustments needed to minimise missing items. Not all patients accepted algorithm-indicated interventions, but a yield of 43% with symptoms having potentially reversible causes detected is clinically useful. Nurses endorsed ease and utility of the implementation process. Optimise now needs clinical effectiveness to be assessed.https://bmjopengastro.bmj.com/content/11/1/e001585.full |
| spellingShingle | Thomas Hamborg John McLaughlin Ailsa Hart Christine Norton Sonia Bouri Laura Miller Jean-Frédéric LeBlanc Asma Fikree Imogen Stagg Fionn Cléirigh Büttner Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management BMJ Open Gastroenterology |
| title | Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management |
| title_full | Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management |
| title_fullStr | Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management |
| title_full_unstemmed | Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management |
| title_short | Optimising fatigue, abdominal pain and faecal incontinence in people with inflammatory bowel disease (IBD-BOOST Optimise): feasibility study of a checklist and algorithm for initial nurse-led management |
| title_sort | optimising fatigue abdominal pain and faecal incontinence in people with inflammatory bowel disease ibd boost optimise feasibility study of a checklist and algorithm for initial nurse led management |
| url | https://bmjopengastro.bmj.com/content/11/1/e001585.full |
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