Perceptions of Fecal Microbiota Transplantation: Factors That Predict Acceptance: A Preliminary Analysis

Abstract

Introduction: Fecal microbiota transplantation (FMT) has recently gained attention for its ability to treat refractory and recurrent Clostridium difficile infection, an illness that can affect quality of life and increase healthcare costs. Despite its effectiveness, many patients are reluctant to accept FMT. Our study examines attitudes towards FMT and factors that contribute to making this therapy an acceptable alternative for some, but not others. Methods: We created a survey to collect demographic data and assess patients’ attitudes toward FMT. The surveys were distributed over 3 months at the gastroenterology clinics of a Veteran’s Affairs hospital and a faculty group practice of an urban academic medical center. Statistical calculations were performed using STATA software. Pearson χ2 analysis was performed on univariate factors that may account for FMT acceptability. Multivariable logistic regression was performed to account for having children, being married, education, history of herbal medications, and C. difficile experience (either personally or through a friend or relative). Results: At the time of submission, most respondents were male (73%), white (61%), and veterans (70%). Overall, 27% were familiar with C. difficile, 15% (24/160) knew of FMT prior to the survey, and 75% (109/146) would undergo the procedure if medically indicated. On univariate analysis, subjects with children were more likely to agree to FMT (82% vs. 62%; p=0.01). No other factors were significantly associated with FMT acceptability, including history of chronic diarrhea, use of herbals, or prior experience with C. difficile infection (Table 2). There was a trend towards willingness for FMT among those who were married vs. unmarried (85% vs 70%; p=0.06) and those with university or graduate degrees vs. those with less than a college education (78% vs 31%; p=0.05). The only independent predictor of accepting FMT on multivariable model was having children (OR 2.87; 95% CI 1.24, 6.66). Between colonoscopy, NGT, and enemas, 65 respondents (70%) chose colonoscopy as the most acceptable vehicle for stool transplant,while NGT was the least preferred. Disease transmission was the most common concern regarding stool transplants (25.54%; n=184) and embarrassment was the least selected concern (8.15%). Conclusion: Among patients surveyed, 27% were familiar with C. difficile, though the majority had no prior knowledge of FMT. Having children was a significant predictor for accepting FMT, suggesting that parents may be more willing to try emerging therapies for the sake of their loved ones. Of note, subjects who were married also trended towards finding FMT acceptable. The main concern for undergoing FMT was the risk of disease transmission.