Evidence mapPaperPMID 42340521Full record

ArticleDigestive diseases and sciences2026

Navigating Treatment Selection in Acute Severe Ulcerative Colitis: A Prospective Mixed Method Analysis of Factors Influencing Patient Decision-Making.

Reid Herran, Samuel Wilcox, Gal Hodish, Syed A Hassan, Haley Mertens, Christopher V Almario, Philip Gu, Maia Kayal, Shirley Cohen-Mekelburg, Randolph E Regal and 5 more

Abstract read
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In one paragraph

Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Reid HerranDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.ORCID http://orcid.org/0000-0002-4833-0290
Samuel WilcoxDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Gal HodishDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.ORCID http://orcid.org/0009-0003-7352-9503
Syed A HassanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Haley MertensDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Christopher V AlmarioDepartment of Medicine, Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Philip GuF. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0003-4819-8979
Maia KayalDivision of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.ORCID http://orcid.org/0000-0002-9640-950X
Shirley Cohen-MekelburgDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Randolph E RegalDepartment of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA.ORCID http://orcid.org/0000-0001-7984-9338
Shrinivas BishuDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.ORCID http://orcid.org/0000-0003-4823-5805
Corey A SiegelCenter for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.ORCID http://orcid.org/0000-0002-2240-6605
Melissa DeJonckheereDepartment of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
Peter D R HigginsDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Jeffrey A BerinsteinDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. jberinst@med.umich.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAcute severe ulcerative colitis (ASUC) is a life-threatening medical emergency necessitating immediate hospitalization and rapid initiation of therapy. For decades, intravenous (IV) corticosteroids have remained first-line, with rescue therapies reserved for patients who are corticosteroid-refractory. However, the therapeutic landscape has evolved, shifting toward earlier initiation of advanced therapy. This study analyzes factors influencing patient decision-making for treatment of ASUC.

methodsIn this prospective, mixed-methods study, patients with ASUC who were infliximab and Janus kinase inhibitor naïve were enrolled. Participants were presented with educational resources on IV corticosteroids, upadacitinib, and infliximab and then asked to choose between continuing IV corticosteroids alone or starting early initiation of advanced therapy in addition to IV corticosteroids. Factors influencing their preferences were captured via semi-structured interviews, and clinical outcomes were followed.

resultsEleven patients were prospectively enrolled. Analysis of semi-structured interviews revealed five dominant themes influencing treatment decision-making: (1) reliance on physician expertise, (2) contextualized treatment selection, (3) concrete risk assessment, (4) empathetic individualization, and (5) strong preference for oral therapy. Notably, we observed significant discordance between patient treatment preferences and medication initiated following discussion between the participant and their primary clinical team, particularly among participants favoring upadacitinib.

conclusionThese five principal themes offer actionable opportunities to assist patients in making well-informed decisions regarding ASUC therapy. Clinicians should utilize these insights to develop evidence-based patient decision aids that specifically address patient priorities. While patients often prioritize oral therapy, their choices often diverge from the therapy initiated after discussing with their primary clinical team. Future efforts should focus on bridging this discordance by integrating patient priorities with available evidence into the clinical decision-making process.

Indexed as

Acute severe ulcerative colitisJanus kinase inhibitorsUlcerative colitisUpadacitinib

Identifiers

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.