Abstract
BACKGROUND: Fecal microbiota transplantation (FMT) is under active investigation as a popular treatment option for a variety of diseases, including ulcerative colitis (UC). Despite increasing evidence for its therapeutic role, the current literature is limited in its scope to assess firsthand patient experiences. AIMS: To exlore perceptions, attitudes, and experiences of patients who chose to pursue FMT and patients who declined FMT in favor of conventional medications. METHODS: Using qualitative descriptive design, eligible patients were invited to participate in face-to-face semi-structured interviews before and after FMT treatment. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. RESULTS: Main baseline themes across the FMT (n=9) and non-FMT (n=8) groups included: (i) knowledge of FMT, (ii) attitudes around FMT, and (iii) factors contributing to the decision to pursue FMT. Post-FMT themes included: (i) experiences with FMT, and (ii) perceived response to treatment. We found a poor general understanding of FMT across both cohorts, suggesting a need for improving patient education. Non-FMT patients were less likely to have heard or researched FMT in the past due to feelings of “it just sounds weird”. Similar concerns were found across both groups, including fear of transmissible infections, cost of an experimental therapy, and aversion to stool. Expectations varied between the two groups, with feelings of hope and a sense of “last resort” driving patients to pursue FMT. In contrast, the non-FMT cohort felt a need to further research FMT, explore other treatment options before committing to FMT, and were more likely to describe their disease activity as “not at the severe end”. This demonstrates that FMT may be perceived as a “last ditch effort”. Despite initial aversion, the non-FMT group demonstrated interest in learning more about FMT and felt more open to the possibility of pursuing FMT in the future. The FMT group was more likely to harbor a positive view of natural medicine and classify FMT as natural, while the non-FMT cohort expressed “I’m not really into the weird stuff”. Post-FMT, some patients expressed delight in the perceived changes in their symptoms, including improved quality of life, decreased urgency, and less concerns with accidents. CONCLUSIONS: Our results suggest that important motivating factors for pursuing FMT are a perception of naturality and a sense of last resort. With improved education, FMT may pose an acceptable and tolerable treatment option for patients with UC. FUNDING AGENCIES: Canadian IBD (CANIBD) Nursing