Partnering with Your Doctor
The Treat-to-Target approach to IBD Care
We know how important it is to treat the significant symptoms you are feeling right now, while you are simultaneously working with your healthcare team to find the right long-term treatment plan for your inflammatory bowel disease (IBD). And we also know that you don’t want IBD to stand in your way: you should be able to live your fullest life, all the time.
The best way to balance your short- and long-term goals is through being an effective partner with your healthcare team. Finding the right IBD treatment can take time, so it’s important to balance your present priorities and the future course of your disease. This helps in avoiding complications, and minimizing long-term disease risks as much as possible.
This goal-oriented approach to managing IBD is much like setting a target and trying to hit the bullseye. It can’t be done by your provider alone; you need to be an active partner in the goal-setting discussion. This process is often called “treat-to-target” in the medical community, and for patients this means working with your health care team to establish clear short- and long-term goals – in other words, being a partner in your own IBD care.
Treat-to-target is a way of improving your IBD care and outcomes by working with your doctor to identify specific treatment goals (setting a target) and monitoring your progress toward those goals. To achieve your goals, your doctor will regularly check to make sure your body and disease are responding to the treatment strategy that you decide on during certain points in your care. If there is not enough improvement, your doctor and healthcare team will discuss what changes they may advise to help you reach your goal. Medical guidance is clear that the ultimate goal for IBD is to achieve no evidence of inflammation or active disease; check out our latest webinar for more details!
Your role in effective partnering
Talk with your provider and take an active role in your own care. This means being clear with your provider in discussing your preferences and setting goals. Our Conversation Guide and Goal Tracker can help you get started.
Start with sharing your personal goals and preferences for treatments with your doctor. For example, do you prefer taking injections or oral medications? Do you have time in your day to dedicate to a long infusion? You may also want to consider and discuss both long- and short-term goals. An example of a long-term goal could be to maintain a regular, full-time work schedule, or to start a family. A short-term goal could be to reduce the frequency of diarrhea, reduce or stop abdominal pain, or to attend a family wedding in two months.
Effective partnering gives you and your family the opportunity to have a say in your treatment plan and be informed about your treatment options.
When you work with your doctor to set a goal, you will both agree on what you want to achieve with your disease management. These goals, or targets, will be different based on the type, severity, and progression of your disease as well as your age, symptoms, co-existing and/or pre-existing conditions, and other social and emotional factors. You may set a single goal, multiple goals, or even a moving one.
Examples of goals:
- Physical goals: reduce or eliminate symptoms, such as abdominal pain or stool frequency
- Medical goals: reduce inflammation or improve labs
- Life goals: return to work, school, or volunteer activities, start a family, gain self-care skills, attend a social event, or eat at a restaurant
- Mental health goals: decrease stress, frustration, and anxiety, improve confidence, or experience better peace of mind
Goals do vary, but many gastroenterologists who care for patients with IBD consider the ultimate one is to achieve no evidence of inflammation or active disease—which is considered mucosal healing, or (at a deeper level) histologic remission. These are further explained in the next section.
Types of remission
Remission is a term that many people with IBD think of as “the absence of symptoms.” However, remission can take different forms, depending on what is being observed:
Symptom control/clinical remission is the resolution of active IBD symptoms. This type of remission may come with a higher long-term risk of flaring and treatment failure compared with endoscopic or deep remission described below. This is because the treatments are focused on relieving your current symptoms, which can be helpful for patients to feel better. Other types of remission may target healing the damage and inflammation caused by your disease, as noted below.
Mucosal healing refers to an absence of active disease seen during a colonoscopy (e.g., no ulcers, no bleeding). Aiming for mucosal healing lowers your risk of complications such as strictures and fistulas.
Histologic remission occurs when no active inflammation is seen at the tissue level (when biopsies taken during a colonoscopy are examined under the microscope).
Your provider(s) will prescribe treatments or in some cases recommend surgery to reach these remission goals.
Your doctor will assess the progress towards the goals for your IBD care using a variety of diagnostic and prognostic tests.
Diagnostic tests gather information to help healthcare providers make a decision or intervention for your health (for example, changing the dose of your medication).
Prognostic tests can help predict how likely you are to develop a disease or how severe your disease will become.
Click here for more information on diagnosis and testing.
Changing your goals
It may take some time before you see any progress made toward achieving your goal. Certain treatments may take some time to work; depending upon the medication, it could be weeks or even months. It is important to talk to your doctor about how much time to allow before you can be certain whether the treatment is meeting your goals.
Although you and your doctor will aim for the best possible outcome, you may experience challenges that prevent you from reaching your target or goal. For some patients, the medication simply may not be working. For others, insurance obstacles or financial hardships may hinder getting the treatment that was prescribed. Here are a few suggestions to consider discussing with your doctor if you are not reaching your goal:
- Review any external factors that may be impacting the effectiveness of your treatment. For instance, are you taking the medication as instructed? Is your work or school schedule impacting your treatment plan?
- Talk to your doctor about adjusting your treatments. Changes to your treatment plan will need to take into account your IBD history, especially previous medications that you have taken in the past.
- Consider changing your target if currently available treatments are not helping you reach your goal.