Assessing Bowel Urgency in Clinical Practice: Results From a Healthcare Professional Survey

Introduction: Bowel urgency (BU) is a common symptom reported by patients with ulcerative colitis (UC) and Crohn’s disease (CD) and has been shown to negatively impact patients’ emotional, psychological, and social functioning. The current study was designed to provide insight into real-world experiences and perspectives around the management of UC and CD by healthcare professionals (HCPs), including how they assess BU in clinical practice. Methods: This was a cross-sectional, web-based survey among HCPs who manage patients with UC and CD in the United States. The sample included 100 gastroenterologists (GIs); 154 family or internal medicine or primary care physicians (FM/IM/PCPs); 101 physician assistants (PAs); and 104 nurse practitioners (NPs) recruited through a national HCP panel. Data were collected from November 21, 2022, through December 6, 2022. The survey included a question about how HCPs currently assess BU in practice; a description of the Urgency Numeric Rating Scale (UNRS), a validated 11-point scale where 0 = no urgency and 10 = worst possible urgency; and an assessment of HCPs’ willingness to use the UNRS in clinical practice. Results: Among 459 HCP participants (Table 1), 51% reported that they ask patients a yes/no question to assess BU, 23% use the UNRS, 14% use a different measure, and 12% do not use any measure. Current use of the UNRS was higher among PAs (29%) and FM/IM/PCPs (27%) than NPs (19%) and GIs (14%) (Figure 1). Among those who indicated that they use a different measure (n = 66), 46% use the UC Patient-Reported Outcomes Signs and Symptoms (UC-PRO/SS), 39% use the Symptoms and Impacts Questionnaire for CD or UC (SIQ-CD or SIQ-UC), and 26% use the Simple Clinical Colitis Activity Index (SCCAI). On a 5-point scale, of those not using the UNRS (n = 354), 89% were somewhat, very, or extremely willing to use it (Figure 1). There were differences by specialty. Conclusion: Given the negative impact of BU on patients’ quality of life, it is important for HCPs to fully assess BU when managing patients with UC and CD. The UNRS is a single-item question that offers HCPs a better understanding of the current severity of a patient’s BU rather than asking a dichotomous yes/no question and takes less time for a patient to answer than other measures. The UNRS is a scale that is a more useful tool to assess the severity of BU in clinical practice. Efforts to inform HCPs of this new measure, especially GIs, can help them better manage patients with UC and CD. Table 1. - HCP Characteristics Type of Healthcare Provider Overall (N = 459) GIs (n = 100) FM/IM/PCPs (n = 154) PAs (n = 101) NPs (n = 104) Primary medical specialty Gastroenterology 173 (37.7%) 100 (100.0%) 0 37 (36.6%) 36 (34.6%) Internal medicine 59 (12.9%) 0 20 (13.0%) 20 (19.8%) 19 (18.3%) Primary care/family care 227 (49.5%) 0 134 (87.0%) 44 (43.6%) 49 (47.1%) Type of primary work environment Private practice, solo 56 (12.2%) 9 (9.0%) 22 (14.3%) 15 (14.9%) 10 (9.6%) Private practice, group 228 (49.7%) 54 (54.0%) 79 (51.3%) 49 (48.5%) 46 (44.2%) Managed care or HMO practice 12 (2.6%) 0 7 (4.5%) 2 (2.0%) 3 (2.9%) Hospital, inpatient service 28 (6.1%) 4 (4.0%) 6 (3.9%) 8 (7.9%) 10 (9.6%) Outpatient clinic (e.g., ambulatory care center, urgent care center) 78 (17.0%) 7 (7.0%) 32 (20.8%) 20 (19.8%) 19 (18.3%) Academic medical center 55 (12.0%) 25 (25.0%) 7 (4.5%) 7 (6.9%) 16 (15.4%) Other (e.g., research, administration) 2 (0.4%) 1 (1.0%) 1 (0.6%) 0 0 Description of primary work location Rural 57 (12.4%) 2 (2.0%) 21 (13.6%) 20 (19.8%) 14 (13.5%) Suburban 233 (50.8%) 50 (50.0%) 87 (56.5%) 46 (45.5%) 50 (48.1%) Urban 169 (36.8%) 48 (48.0%) 46 (29.9%) 35 (34.7%) 40 (38.5%) Figure 1.: Current use of the UNRS.