Medical consultation in ulcerative colitis: Key elements for improvement

Table 1 Overarching principles for the clinical consultation in patients with ulcerative colitis

No.	Overarching principles
1	Appropriate environment where the clinical consultation takes place (tidy, clean, a chair for accompanying person, etc.)
2	Motivational interviewing
3	Use of appropriate verbal and non-verbal language
4	Good manners (salutation, face to face interaction, etc.) and empathy
5	Be honest about what we know, what we do not know and describe actions regarding what to do/what to avoid
6	Ideally prepare and organize the clinical consultation before seeing the patient (medical history, check labs, imaging tests, etc.)
7	Establish the objectives of the clinical consultation:
	Adapted to each clinical scenario
	Adapted (including the message) to each patient’s features
	Taking into account patient's opinion and preferences

Table 2 Adapting the consultation to the different clinical scenarios when managing patients with ulcerative colitis

No.	Clinical scenario	Objectives	Key elements
1	Diagnosis/first visits	To engage patients in the management of their disease (treatments, visits, labs, image techniques, contact data, etc.); To inform wisely patients; To collect relevant data about the disease, patients and their environment	Use open questions rather than direct questions; Practice empathy: a climate of trust will make the patient feel comfortable and more information will come out naturally; When informing patients go as far as the patient needs or wants, e.g., “What do you know about UC?”; Explore people’s understanding, reactions and opinions about UC information; Explain the therapeutic plan (treatment objectives and goals, available therapies including surgery, response evaluation, etc.); Prepare the consultation: check labs, imaging tests or other available data before seeing the patient and prepare specific attitude, procedures or messages
2	Follow-up visits	To evaluate response to treatment (induction/maintenance), safety and adherence; In the induction phase, to ensure that the patient has achieved the pre-defined objective/goal; In the maintenance phase, to assure that the patient is really in remission and adherent; To explain test results	Use open questions; Solution-focused approach; Let the patients express themselves about their life (family, partner, work/studies, social life, traveling, diet, etc.): e.g., “How are you doing? Are you doing everything you would like to do?”; Be open to patients asking questions; Detail the therapeutic and follow-up plan (e.g., colonoscopy for colon cancer surveillance as indicated); Assess sexuality and fertility issues; Assess pregnancy desire: e.g., when informing about drugs; Practice empathy; Prepare the consultation (see point 1)
3	Patients with active disease	To assess carefully the impact of UC on the patient’s life (family, partner, work/academic, social life, traveling, diet, etc.); To adapt the treatment and patient’s environment	Explain the therapeutic plan in detail but mainly explain and agree on what the objectives are, treatment goals and options, including surgery (informed shared decision making); Practice empathy; Prepare the consultation (see point 1)
4	Patients on topical therapies	To look for treatment acceptance and adherence	Explain in detail and clearly that topical therapies can be very effective with few adverse events (very good risk/benefit balance); Solution-focused approach; Discuss about the costs, explain their mechanism of action and options to improve comfort; Evaluate the patient’s opinion and preferences; Practice empathy
5	Start of a new treatment	To assess carefully the impact of UC on the patient’s life (family, partner, work/studies, social life, traveling, diet, etc.); To adapt the treatment and patient’s environment; To fully understand the implications of starting a new treatment (changes in daily life, etc.)	Explain in detail and clearly the therapeutic plan but especially safety issues and new adaptations in patient’s life; Solution-focused approach; Practice empathy; Prepare the consultation (see point 1)
6	Refractory patients	To assess carefully the impact of UC on the patient’s life (family, partner, work/studies, social life, traveling, diet, etc.); To adapt the treatment and patient’s environment	Explain the therapeutic plan in detail but mainly explain and agree on how far we are going to go, which are the treatment goals and options, including surgery (shared decision making); Solution-focused approach; Be especially cautious as non-standard treatments/strategies might be considered (e.g., off-label uses, clinical trials, etc.); Spread positivity, make the patients feel accompanied; Screen for depression/dysthymia; Practice empathy; Prepare the consultation (see point 1)
7	Extra-intestinal manifestations	To inform patients about other symptoms or diseases	Explain the therapeutic plan in detail but mainly explain and agree on how far we are going to go, which are the treatment goals and options, including surgery (shared decision making); Solution-focused approach; Introduce the concept of multidisciplinary and coordinated care; Practice empathy; Prepare the consultation (see point 1)
8	Patients with negative feelings or mistrust	To win the patient over; To be patient but solid	Consider referring the patient to a psychologist; Explore fears, insecurities, frustrations; Do not confront the patient; Practice empathy; Explain the therapeutic plan in detail but mainly explain and agree on how far we are going to go, which are the treatment goals and options, including surgery (shared decision making)

For all sections, we start from the fundamentals of shared decision-making. UC: Ulcerative colitis.