Accreditation/Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Physicians’ Education Resource®, LLC and the Rome Foundation. Physicians’ Education Resource®, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Salix Pharmaceuticals and Shire.

The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation

The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. PER. The Rome Foundation.

Release Date: October 31, 2018
Expiration Date: October 31, 2019
Media: Internet - based
 

Activity Overview

Functional gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC) have a sizeable impact on patients’ quality of life and contributive to high absenteeism from work and withdrawal from social activities. A significant obstacle to care is that the conditions go undiagnosed in most patients, so they do not seek treatment until symptoms become severe. Even when seeking treatment, however, barriers to effective communication between the patient and provider may lead to unnecessary testing and increasing frustration when a specific diagnosis is not imminent. A patient-centered approach that focuses on effective communication is associated with improved outcomes, increased patient satisfaction, and decreased utilization of care.

This activity provides comprehensive strategies for earlier diagnosis using effective communication techniques that lead to appropriate treatment and better quality of life for patients with functional GI disorders. As a Patient and Provider Connection™, 2 patient stories will illustrate the patient’s treatment experience and perspective, followed by insightful commentary from expert faculty and a patient. Effective communication tactics will be presented and then exemplified in shared decision making and effective and noneffective video examples provided by DrossmanCare. Through a partnership with the ROME foundation, diagnostic evaluation algorithms will be presented and demonstrated with patient cases using the ROME IV Interactive Clinical Decision Toolkit. This intelligent software program includes a continually updated database that incorporates the Multidimensional Clinical Profile (MDCP) texts and diagnostic algorithms in a decision pathway from patient assessment to treatment.

Accreditation/Designation of Credit Statements

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Physicians’ Education Resource®, LLC and the Rome Foundation. Physicians’ Education Resource®, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Salix Pharmaceuticals and Shire.

Instructions for This Activity and Receiving Credit

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a CME certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience

This continuing medical education (CME) activity is intended primarily for gastroenterologists, primary care providers, OB/GYNs, pharmacists, nurse practitioners, nurses, and physician’s assistants who treat patients with IBS or CIC.

Educational Objectives

Upon successful completion of this educational program, you should be better prepared to:

  1. Identify the key symptoms and diagnostic criteria for IBS and CIC
  2. List the key features of mild, moderate, and severe IBS that incorporate symptom severity and psychosocial features and differentiation from CIC.
  3. Describe the medications used for IBS with diarrhea and IBS with constipation and CIC symptoms according to their actions and recent clinical trial data
  4. Outline several guidelines for establishing a therapeutic relationship that have been helping patients increase participation in their care

Additional Resources

The presentation of these materials does not constitute an expressed or implied endorsement from PER or the supporters.

Websites

Resources:
Katie: A Patient’s Perspective
Katie: The Physician’s Perspective of a Young Woman’s Illness

Faculty, Staff, and Planners' Disclosure

Faculty

Douglas A. Drossman, MD
President, Rome Foundation
Professor Emeritus of Medicine and Psychiatry
University of North Carolina Center for Functional GI and Motility Disorders
University of North Carolina
Center for Education and Practice of Biopsychosocial Patient Care and Drossman
Gastroenterology
Chapel Hill, North Carolina

Disclosure: Consultant: BioAmerica, Salix, Shire - Speaker’s Bureau: AbbVie

Albena D. Halpert, MD
Assistant Professor of Medicine
Division of Gastroenterology and Hepatology
Boston University School of Medicine
Gastroenterologist
Pentucket Medical Associates
Haverhill, Massachusetts

Disclosure: Advisor Board: Allergan, Shire -Spouse’s employment: Pharmacist at Walgreens

Johannah Ruddy, MEd
Executive Director
Rome Foundation
Raleigh, North Carolina

Disclosure: No financial relationships to disclose.

Katie
Patient Contributor

Disclosure: No financial relationships to disclose.

The staff of Physicians’ Education Resource®, LLC have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.
 
Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician or nurse relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recaps

1 of 3
Per Pulse™ Recap:
The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation

The online continuing medical education (CME) activity The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation features a roundtable discussion with case studies using the Rome IV Interactive Clinical Decision Toolkit for the diagnosis and management of patients with irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Patient stories and engaging tactics are shared to demonstrate effective communication. Expert faculty Douglas A. Drossman, MD; Albena D. Halpert, MD; and Johannah Ruddy, MEd, patient and executive director of the Rome Foundation, provide perspectives on diagnosis and treatment of IBS and CIC using the Multidimensional Treatment Clinical Profile (MDCP), as well as insight from a patient perspective on the challenges of obtaining an accurate diagnosis.

This first of 3 PER Pulse™ Recaps will focus on the key symptoms and diagnostic criteria for IBS and CIC, as explored in the online CME activity The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation.

IBS is one of several chronic functional gastrointestinal (GI) disorders recognized as disorders of gut–brain interaction, affecting 7% to 16% of adults in in the United States.1 Women are at greater risk than men, and individuals <50 years of age are at increased risk versus those >50.2 IBS symptoms can be extremely burdensome and have a significant impact on patients’ quality of life and social function.

IBS is characterized using the Rome criteria:

Recurrent abdominal pain or discomfort must be present for at least 1 day/week in the past 3 months and associated with 2 or more of these features:

  • Related to defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in the appearance of stool

IBS is subdivided into categories of IBS with diarrhea (IBS-D) or constipation (IBS-C). A physical exam will rule out any alarm symptoms and allow for a positive predictive diagnosis.

CIC has a global prevalence of 14%3 and is also defined as a disorder of gut–brain interaction with these Rome criteria:

  • Fewer than 3 bowel movements per week, accompanied by hard or lumpy stools, straining, and a feeling of incomplete bowel movements
  • No pain present, unlike the abdominal pain that is a defining feature of IBS-C

Diagnosis of IBS and CIC can be a lengthy, difficult process for patients because there are no structural abnormalities, and clinicians may overdo diagnostic testing. Furthermore, patients can become dissatisfied and frustrated with their care and may become hypervigilant to their symptoms and develop anxiety. Use of the Rome criteria and effective patient–provider communication can facilitate an earlier diagnosis and initiation of treatment.

“Most people with IBS don’t seek care, simply because they don’t consider their symptoms part of something that could be treatable. It’s really more just described as ‘My stomach’s acting up. I have a bug.’ Discussing those symptoms can be embarrassing, uncomfortable to bring up. And generally, clinicians aren’t asking about GI symptoms, either, especially in their annual physical exams or well-child visits.”
—Johannah Ruddy, MEd

Key Points

  • IBS and CIC are common functional GI disorders recognized as brain–gut disorders.
  • Rome criteria can provide a positive predictive diagnosis of IBS and CIC.
  • Diagnosis of both disorders is frequently protracted because there is no associated structural abnormality.

References

  1. Ford AC, Lacey BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(27):2566-2578. doi: 10.1056/NEJMra1607547.
  2. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721 doi: 10.1016/j.cgh.2012.02.029.
  3. Black CJ, Ford AC. Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management. Med J Aust. 2018;209(2):86-91.

2 of 3
Per Pulse™ Recap:
The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation

As a follow-up to the online CME activity The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation, this second of 3 PER Pulse™ Recaps will focus on medications used to treat irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC).

“For mild IBS-C and CIC, knowing the difference, that pain is usually not a predominant feature in CIC, [tells us if] osmotic agents like polyethylene glycol (PEG) can be used. However, when pain is present, we need the pharmacologic treatments.”
—Douglas A. Drossman, MD

Although dietary modifications are usually the first step to reduce symptoms, there are no specific IBS diets. Soluble fiber helps some patients with constipation, prebiotics and probiotics can modulate gut flora, and a diet low in FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) can reduce bloating.1 However, it is the process of eating and filling the stomach that leads to the sensitization response.

Mild, meal-related IBS with diarrhea (IBS-D) symptoms can be alleviated with loperamide, antispasmodics, or other OTC products.

FDA-approved options are available for more severe IBS-D and are grouped together for IBS with constipation (IBS-C) and CIC.

Moderate to Severe IBS-D Treatment Options

  Alosetron2  Eluxadoline3 Rifaximin4
Mechanism of action Selective 5-HT3 receptor antagonist Mixed µ-opioid agonist, δ-opioid receptor antagonist, and κ-opioid receptor agonist that interacts with opioid receptors in the gut
 
 
Semisynthetic derivative of rifampin that inhibits bacterial protein synthesis
 
Indications IBS-D in women  
IBS-D in adults
 
Contraindicated in patients post cholecystectomy
 
 
  • IBS-D in adults
  • Traveler’s diarrhea/Escherichia coli
  • Reduction in risk of overt hepatic encephalopathy recurrence in adults

IBS-D indicates irritable bowel syndrome with diarrhea.

 IBS-C and CIC Treatment Options

  PROSECRETORY MEDICATIONS PROKINETIC
  Linaclotide5 Lubiprostone6 Plecanatide7 Prucalopride8
Mechanism of action Guanylate cyclase-C agonist
 
Locally acting chloride channel activator; specifically, C1C-2
 
 
Guanylate cyclase-C agonist
 
 
Guanylate cyclase-C agonist
 
Indications IBS-C in adults;
CIC in adults
 
 
IBS-C in women ≥18 years
Opioid-induced constipation in adults with chronic, noncancer pain
IBS-C in adults;
CIC in adults
 
 
 
 
 
CIC in adults

CIC indicates chronic idiopathic constipation; IBS-C, irritable bowel syndrome with constipation.

Besides pharmacotherapy, treatment may include behavioral therapy and centrally modulating agents to address the brain–gut interaction, especially for severe symptoms.

Key Points

  • Mild symptoms can be relieved with OTC products.
  • FDA-approved treatments are available for moderate to severe symptoms or when pain is present in IBS-C.
  • Behavioral therapy and centrally modulating agents may be necessary for more severe symptoms

References

  1. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP diet improves irritable bowel syndrome symptoms: a meta-analysis. Nutrients. 2017;26;9(9):pii: E940. doi: 10.3390/nu9090940.
  2. Lotronex [prescribing information]. Roswell, GA: Sebela Pharmaceuticals, Inc; 2016. www.lotronex.com/hcp/. Accessed May 10, 2019.
  3. Viberzi [prescribing information]. Madison, NJ: Allergan USA, Inc; 2018. www.viberzihcp.com. Accessed May 10, 2019.
  4. Xifaxin [prescribing information].Bridgewater, NJ: Salix Pharmaceuticals, a division of Valeant Pharmaceuticals North America LLC; 2018. www.xifaxan.com/hcp/. Accessed May 10, 2019.
  5. Linzess [prescribing information]. Madison, NJ: Allergan USA, Inc; 2018. www.linzesshcp.com Accessed May 10, 2019.
  6. Amitiza [prescribing information]. Bedminster, NJ: Sucampo Pharma Americas, LLC and Deerfield, IL: Takeda Pharmaceuticals America, Inc; 2018. www.amitiza.com/hcp/dosing. Accessed May 10, 2019.
  7. Trulance [prescribing information]. New York, NY: Synergy Pharmaceuticals, Inc; 2018. https://trulancehcp.com/. Accessed May 10, 2019.
  8. Motegrity [prescribing information]. Lexington, MA: Shire US, Inc; 2018. www.motegrityhcp.com/. Accessed May 10, 2019.

3 of 3
Per Pulse™ Recap:
The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation

As a follow-up to the online CME activity The Patient and Provider Connection™: Effective Communication to Optimize the Diagnosis and Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation, this third of 3 PER Pulse™ Recaps will focus on tips and techniques for optimizing the patient–provider relationship.

“Patients come to us to talk about their illness, and physicians talk about diagnosis and symptoms. Showing interest in the patient’s quality of life builds empathy and a relationship by looking at the patient as a whole person. Effective communication is really addressing what the patients are there for, rather than our agenda.”
—Albena D. Halpert, MD

Confirming the diagnosis for a patient with irritable bowel syndrome (IBS) or chronic idiopathic constipation (CIC) alleviates stress and fear of the unknown. However, the pathway to reaching that diagnosis requires effective patient–provider communication for disorders of gut–brain interaction. During the activity, faculty reacted to video clips that first demonstrated ineffective communication between a patient and their healthcare provider and then effective communication. Discussion centered around 9 areas in which the healthcare provider could improve communication. Following are highlights from 3 of those areas:

Listen Actively

As clinicians, we may think that we listen to patients, but often we’re thinking about what we want to ask next. Active listening is using the information heard from the patient to formulate your next question. Nonverbal cues, such as good eye contact and body language that demonstrates engagement in the discussion, also play a major role.

Identify the Agenda

By the time a patient with a functional gastrointestinal (GI) disorder pursues a diagnosis or follow-up, they have many questions and concerns. If pain is involved, they are frequently fearful of cancer. They could feel that their symptoms are worse, have insurance questions, or be worried and stressed. These questions will lay the foundation for a productive patient encounter:

  • Set the agenda by asking “What brought you here today?”
  • Identify what is called the patient’s “scheme” by asking “What do you think is going on?”
  • Ask the patient about any worries or concerns so reassurance can be offered.
  • Establish patient’s expectations: “What do you think I can do to help you?”

Empathize

Showing empathy is a way to provide an understanding of the patient’s perspective; eg, “I can see how difficult it has been to manage with the pain you’re experiencing.” Ways to exhibit empathy include1:

  • Test the patient’s perspective.
  • Be nonjudgmental so you can hear what the patient is saying.
  • Recognize the patient’s emotions, whether they involve anxiety, fear, or anger.
  • Communicate your identification of the patient’s emotions.

Key Points

  • Effective patient–provider communication is essential to optimizing outcomes in functional GI disorders.
  • Providers have opportunities to improve communication with patients by first listening actively, identifying the patient’s agenda, and empathizing with concerns or fears.

Reference

  1. Wiseman T. A concept analysis of empathy. J Adv Nurs.1996;(23)6:1162-1167.

Login or Register to Start Activity

Please use the form below to Register or Log In to begin Activity.

*Required Fields
Calendar of Events
SUNMONTUESWEDTHURSFRISAT
1234567
891011121314
15161718192021
22232425262728
2930
Filter By