Patient Perceptions
Patients with recurrent CDI are desperate for a cure and may seek guidance from online communities. Many are willing to travel great distances to undergo FMT. Some have even resorted to performing home enemas of donor stool when they are unable to find a physician who is willing or able to perform FMT. In fact, a YouTube video describing do-it-yourself FMT has been viewed more than 45,000 times. Limited studies of patient perceptions regarding FMT performed to date report that patients recognize the unappealing nature of FMT yet are still open to considering it as a treatment, especially when recommended by a physician. This willingness on the part of patients to try FMT holds true regardless of their prior experience with FMT or the nature of their disease (CDI, UC, or healthy patients). For example, in a survey of healthy patients who were presented with hypothetical scenarios related to treatment options for recurrent CDI, 81% of patients chose FMT. Similarly, a survey of patients with UC at a single tertiary care center showed that, despite reporting satisfactory to excellent disease control with their treatments, the vast majority were interested in or willing to consider FMT. Subjects who had been hospitalized were more willing to undergo FMT (55% vs 34%, P = .035), suggesting an implied risk/benefit assessment by patients. The investigators believed that the profound interest in FMT reflects the perception that it is a "natural"' treatment for UC as well as dissatisfaction with chronic medical therapy for a variety of reasons. Brandt et al surveyed the perceptions of 77 patients who experienced recurrences of CDI and were treated with FMT; 97% reported that they would want FMT in the event of another recurrence, and 53% would have opted for FMT as primary treatment before a trial of antibiotics for their first recurrence if given the option. With the advent of more aesthetically acceptable protocols, including odorless pills, FMT is likely to appeal to a majority of patients who are deemed eligible for FMT.
Although no studies of potential barriers to the use of FMT by physicians have been published in full form, a recent abstract reporting a survey of physicians showed that 40% were not willing to try FMT, pending further demonstration of its efficacy, safety and perceived patient acceptance. Although there is a Current Procedural Terminology (CPT) code for FMT (44705, "preparation of fecal microbiota for instillation, including assessment of donor specimen"), lack of adequate reimbursement for the time required by physicians may be a further deterrent. Thus, patients seem willing to try FMT, but it is unknown how willing physicians in various specialties are to offer, perform, or refer patients for this treatment.