965. Fecal Microbiota Transplant for Recurrent C. difficile Infection: The Patient Experience
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Background: Fecal Microbiota Therapy (FMT) is an option for recurrent C. difficile infection (CDI).  While effectiveness has been documented, the patient experience of undergoing FMT has not. The objective was to describe the patient experience of undergoing FMT and impact on CDI resolution and aspects of the patient condition.  

Methods: We carried out a qualitative interview study using semi-structured questions relating to aspects of physical and mental health before pre-FMT, during FMT, and post-FMT with 17 patients who underwent FMT between 3/12 to 6/14.  Inductive coding was used to identify core themes during the pre-FMT, FMT, and post-FMT periods. 

Results: Participants mean age was 63 years. They had CDI symptoms for 7 months on average and mean weight loss was 25 lbs.  Pre-FMT themes included: physical (continuous diarrhea, abdominal pain, appetite/weight loss, weakness, sleep disturbances); mental (isolation, depression, wanting to die, fear); quality of life (unable to perform normal activities, missed social events); social support; and financial (medication costs, inability to work) factors.  Provider resistance/limited awareness about CDI and FMT were barriers to FMT treatment. Prior to FMT, patients reached a ‘tipping point’, experiencing feelings of hopelessness about their options and future.  During FMT, patients commented on how easy it was to undergo FMT and lack of an ‘ick factor’.  In the post-period, patients had immediate symptomatic relief, but had residual fears concerning future need for antibiotics and hygiene.  Patient activation was present during all phases.  Pre-FMT examples included information seeking, persistence, and empowerment, with 76% of patients self-referring to FMT.  Post-FMT examples included accountability, advocacy, and empowerment. 

Conclusion: In the pre-FMT period, patients suffered greatly and encountered FMT-barriers in the time leading up to FMT. Undergoing FMT was reported as easy with immediate relief but residual fears remained.  There were displays of patient activation in all FMT time periods, including the seeking of FMT.  Patients could have benefitted from having undergone FMT sooner, demonstrating a need for improvement in provider education and health system barriers regarding FMT.

Amy Pakyz, PharmD, MS, PhD, Pharmacotherapy and Outcome Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, Leticia Moczygemba, PharmD, PhD, Department of Pharmacotherapy and Outcome Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, Lynn Vanderwielen, MPH, PhD, Family Medicine, School of Medicine, University of Colorado, Aurora, CO and Michael Edmond, MD, MPH, MPA, FIDSA, FSHEA, University of Iowa Carver College of Medicine, Iowa City, IA

Disclosures:

A. Pakyz, None

L. Moczygemba, None

L. Vanderwielen, None

M. Edmond, None

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