AUSTIN, Texas – Knowing the burden of inflammatory bowel disease and the constraints of time with gastroenterologists, advanced practice providers and registered nurses need to step into the role of confidant and referral for patients suffering from the mental burden of IBD, according to a experts and patients at the Crohn’s and Colitis Congress.
“It’s so important as providers and RNs that we are routinely screening for anxiety and depression in these patients. The rates of depression range from 15% to 25%,” Nana Bernasko, RN, of Penn State Hershey Gastroenterology, said during her presentation. “Sometimes I just open up with, ‘How are you coping with all of this?’ ‘Are you home all the time?’ ‘Are you able to have a social life?’ ‘Do you feel like you’re secluded because of your disease?’ Start having the conversations with these people and try to put them in contact with the right resources.”
Bernasko discussed mental health in light of health care maintenance. Just as APPs need to discuss vaccinations, bone health, smoking cessation and care such as colonoscopies and pap smears, there is a role for them to offer patients a safe space to discuss the burden of IBD.
She suggested the Patient Health Questionnaire-2 and Hospital Anxiety and Depression Scale as tools to use in assessing patients’ mental health.
In a panel after Bernasko’s presentation, other experts and a patient advocate weighed in as well.
“As a patient, I really can’t emphasize the psychosocial aspect enough. To be perfectly honest, there are many times I’ve been at death’s door or suicidal,” Tina Aswani Omprakash said. Omprakash is living with Crohn’s disease and has undergone more than 20 surgeries for her disease since being diagnosed.
“It’s really, really important for patients, patient’s families to be able to tell the provider this and sometimes providers don’t have the time to delve into these conversations and then it’s extremely important for the APPs and RNs to really delve into this. ‘How are you?’ goes a really, really long way,” Omprakash said. “We can’t wait, necessarily, for a psycho gastroenterology referral. Sometimes time is too short. ... It’s important that the gastroenterologist and their staff to step in and make sure the patient can be stabilized, referred out and handled accordingly, but also that their disease can be stabilized accordingly simultaneously. I cannot emphasize that enough. ...
“If a patient is about to experience surgery or go on a biologic for a very severe prognosis, they should be referred out. They are without a doubt having mental health issues,” she said. “My career and my life were derailed at 24. My Wall Street career basically went out the door with disease. I cannot emphasize enough how much of a toll this disease takes on us. The more severe it is, the more earth shattering it can be for us”
Kimberly Kearns, MS, APN-BC, who moderated the panel, suggested APPs and RNs can be proactive in making each visit one in which patients can safely discuss their mental state.
“We need to talk about it. It becomes part of our goal when we see these patients to open up the door and create an environment that’s comfortable for them to have this discussion with you. Every time you see these patients, making it a part of the routine. So that when they come in, they feel they are in a safe environment so they can tell you,” she said. “Create that comfortable atmosphere ahead of time, when the patient hits rock bottom, it’s a much better route to get them to help faster.”
Bernasko said she lost two patients to suicide related to their IBD.
“Unfortunately, in my career, I’ve had two patients who committed suicide because of their disease and I sometimes take ownership of that because I didn’t do a diligent job to realize they were suffering with so much emotion. I was more focused on their disease activity,” she said. “Make a cognizant effort to ask the right questions. ... You might be surprised what you hear from them.” – by Katrina Altersitz
Reference: Bernasko N. Sp32. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Edlynn E, et al. Sp 33. Presented at: Crohn’s and Colitis Congress; Jan. 23-25, 2020; Austin, Texas.
Disclosures: Bernasko reports a speakers’ bureau and consultant role with AbbVie and Pfizer and receiving an educational grant from Pfizer.