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Improving Eosinophilic Esophagitis Outcomes
Improving Eosinophilic Esophagitis Outcomes via Transitions of Care and Shared Decision-making

Released: September 20, 2024

Expiration: September 19, 2025

Jonathan M. Spergel
Jonathan M. Spergel, MD, PhD
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Key Takeaways
  • Having a collaborative and streamlined transition of care plan for patients with eosinophilic esophagitis (EoE) is crucial for achieving desired health outcomes.
  • Collaborating with patients via shared decision-making is an essential strategy to ensure patients with EoE receive a plan that will help them meet their individualized goals.
  • EoE is a chronic disease state, and patients will require both short- and long-term solutions to optimize their quality of life.

For the best possible treatment of eosinophilic esophagitis (EoE) and to improve patient outcomes, 2 key strategies must be integrated into daily practice by healthcare professionals (HCPs), including transitions of care (TOC) and shared decision-making (SDM).

Setting the Stage for TOC
For patients diagnosed with EoE at a young age, it is important to provide resources to aid their transition from pediatric to adult care. It is necessary to start these discussions, not just when patients turn 18, but when they are closer to 15 or 16. This is when they need to begin feeling a sense of responsibility followed by understanding.

Despite demonstrated benefits of robust and collaborative TOC strategies, institutions may or may not have formalized programs in place to connect young adults with an adult care team. For those in need of bolstering their approach, use of electronic medical record systems will easily transfer records as patients switch from pediatric to adult care. Likewise, scheduling a time for HCPs from both the pediatric and adult care teams to meet with a patient as they approach the transition can be incredibly helpful (typically around the age of 18-20 years). To facilitate this, HCPs managing EoE across the age continuum can network locally to refine this process.

During the TOC process, HCPs must take a patient’s life goals into consideration. Patients wanting to attend distant education programs or travel will not want to forego their ambitions in order to meet with their transition team. In these cases, coordinated efforts are needed to enable patients to meet with colleagues and transition them over after they finish college or their travels. In other cases, patients may be connected with a specialist once they relocate and settle into new communities.

Empowering Patients Through Shared Decision-making
When it comes to shared decision-making, it is important to be honest with patients and to explain all their therapy options in a way that is easy to understand. HCPs must discuss the factual details about the expected efficacy and adverse events of each option. Patients may ask, “What would you do if it was you or your child?” In these moments it is crucial for specialists to recognize patients at the individual level. For example, patients may express a fear of needles, a reluctance to changing their diet, a preference for high efficacy with a bit more risk, or a preference for low risk at the expense of some efficacy, so HCPs must consider the benefits and risks and pros and cons of each therapy.

Utilizing Targeted Questions to Improve Patient Outcomes
To improve patient outcomes, HCPs need to consider needs for both short- and long-term management. Like other specialty areas, HCPs who treat EoE need a standardized way of monitoring their patients’ symptoms noninvasively.

Ideally, we would have a surrogate blood marker to monitor a patient’s response to EoE treatment and overall disease burden, such as a hemoglobin A1C in diabetes care, but we currently do not have one. One recommendation to monitor therapy in EoE is to give patients a questionnaire at each visit.

Questions focused on short-term outcomes might include, “How are you doing on your current medication for EoE?” and “Can you eat [trigger foods] without problems?” It is essential to note that asking this question can be tricky because a lot of patients have already given up eating certain foods that lead to symptoms.

Questions that could aid in long-term outcomes might include, “Have you experienced food impactions?”’, “Have you needed an esophageal dilatation?”, and “Have you been able to eat without issues?” Asking targeted questions will assist HCPs in their understanding of the patient’s experience, allowing them to make more informed decisions.

Your Thoughts?
What questions do you ask your patients with EoE to thoroughly assess their symptoms control? Join the discussion by posting a comment below.

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Poll

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Which of the following strategies do you use for TOC for patients with EoE in your practice? (select all that apply)

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