Complex Patient Perspectives on Evolving Diverticulitis Treatment

BackgroundDespite 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. ObjectiveThis study aims to assess patients attitudes regarding participation in a randomized trial of antibiotics versus placebo for acute diverticulitis, including willingness to participate. DesignThis is a mixed-methods study with qualitative and descriptive methods. SettingsInterviews were conducted in a quaternary care emergency department and surveys were administered virtually through a web-based portal. PatientsPatients with either current or previous acute uncomplicated diverticulitis participated. InterventionsPatients underwent semi-structured interviews or completed a web-based survey. Main Outcome measuresRates of willingness to participate in a randomized controlled trial was measured. Salient factors related to healthcare decision-making were also identified and analyzed. ResultsThirteen 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 Ive experienced in the past" were the most important decision-making factors. LimitationsThere 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. ConclusionsPatients 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 trials feasibility and facilitate an informed approach to recruitment and consent.