Healthcare professionals need educating about fatigue

Healthcare professionals need educating about fatigue

November 9, 2011 4:29 pm Published by

We have conducted a survey of the current level of awareness of IBD fatigue among healthcare professionals.  The results show that there is a definite need for more information.  The full article and summary of results can be accessed below

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Early findings from new research suggest that health care professionals need educating about fatigue, writes Marcia Darvell

As many members will be aware, Crohns and Colitis UK has been awarded a £481,242 grant by the Big Lottery Fund for a project on fatigue in IBD. The four year research project (which began in July 2010) is examining the causes of fatigue and will pilot a fatigue assessment tool and interventions to improve the management of fatigue in IBD. The research is being carried out with our partners at Kings College London, University College London, Buckinghamshire New University and Addenbrookes NHS Trust.

The project is divided into a number of work packages. Currently, we have interviewed 20 volunteers with IBD. We will use these data to develop a fatigue assessment tool which we will pilot with people living with IBD.

To help us understand the level of awareness and information needs of fatigue in IBD among healthcare professionals, we distributed questionnaires at the BSG conference in 2011, and also sent the questionnaire to IBD nurses.

The survey has several limitations, particularly its self selected and relatively small sample (94 health care professionals). Despite this, the survey indicates a need for greater information on fatigue and IBD.

We asked health care professionals how often IBD patients report fatigue to them – 37% responded ‘sometimes’, 35% ‘often’ and 20% ‘very often’. Only 7% of respondents stated that patients rarely reported fatigue.

Most respondents’ usual course of action, when faced with a patient presenting with fatigue with IBD in remission would be to check the haemoglobin level and treat if low (92%). Other frequent responses chosen were referral for other diagnostic tests (41%), advice on diet (36%), advice to take more exercise (33%) and advice to get more rest or sleep (31%). Actions mentioned by respondents in the open ended response section of this question, included:

  • Check disease activity and inflammatory markers
  • Holistic interview identifying stressors
  • Referral to IBD nurse, dietician or psychologist (the need for psychological support or referral was mentioned by many respondents)
  • Check drug side effects
  • Assess for depression

Despite 55% of respondents indicating that their patients often or very often report fatigue, and 92% of respondents indicating that patients report fatigue as a problem more frequently than ‘rarely’, the level of self rated knowledge among health care professionals was low:

  • 27% indicated that they had poor knowledge of the likely causes of fatigue in IBD
  • 59% rated their knowledge as ‘fair’
  • only 14% rated their level of knowledge as good or excellent.

The survey results indicate that 40% of health care professionals who responded, actively raise the topic with their patients (often, very often or always). However, a third only raise the topic ‘sometimes’, 18% only ‘rarely’ raised the topic and 8% stated that they never raise fatigue with their patients. As the survey was filled out by a self selected group of respondents who are likely to have above average interest in fatigue, the results suggest that there is a need to increase the profile of fatigue to ensure that patients receive the best care.

A high percentage (68%) of health care professionals surveyed consider that IBD fatigue can be adequately treated in most or some patients. However, given the perception of it being a treatable condition, the reluctance to ask about fatigue in clinics is more perplexing. General comments included:

“I would like to receive some evidence based information to give advice to these patients”

“Fatigue is common and I think the approach should be multidisciplinary including dietician, psychologist, gastroenterologists”

“Its effects are underestimated and poorly understood.”

“It is the single most difficult symptom to manage as those who experience it don’t seem to get any benefit from current strategies.”

“I work with children and young adults, the latter in particular struggle with fatigue. It affects their ability to interact with their peers both at school and socially, this has long term implications for them in adulthood.”

“Complex, under-rated, no resources to deal with it, (psychologically) difficult to define, but common.”

“I believe that fatigue is a major issue but unfortunately still poorly recognised as a problem to IBD patients.”

“Very undertreated in primary care.”

Our Big Lottery Fund Project is intended to produce evidence based information and a fatigue assessment tool that will have practical benefits for people living with IBD. The survey results indicate that healthcare professionals, as well as patients, would welcome greater understanding of fatigue.

If you have any comments on this survey and the issues it raises or queries on the project please email: fatigueproject@crohnsandcolitis.org.uk

 

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