Therapeutic Decision-making from the Perspective of Patients with Relapsing-remitting Multiple Sclerosis
Julia Sabin Munoz1, Elisa Salas Alonso2, Jesús Martín-Martínez3, Antonio Candeliere-Merlicco4, Francisco Barrero5, Ana Alonso Torres6, José Luis Sánchez-Menoyo7, Laura Borrega Canelo8, María Rodríguez-Rodríguez9, Montserrat Gómez-Gutiérrez10, Sara Eichau Madueno11, Miguel Ángel Hernández-Pérez12, Carmen Calles13, Eva Fernández-Díaz14, Olga Carmona15, Aida Orvíz16, Ana López-Real17, Pablo López-Muñoz18, Amelia Mendoza19, Eduardo Aguera Morales20, Jorge Maurino2
1Department of Neurology, Hospital Universitario Puerta de Hierro, 2Medical Department, Roche Farma, 3Department of Neurology, Hospital Universitario Miguel Servet, 4Department of Neurology, Hospital Rafael Méndez, 5Department of Neurology, Hospital Clínico Universitario San Cecilio, 6Department of Neurology, Hospital Regional Universitario de Málaga, 7Department of Neurology, Hospital de Galdakao-Usansolo, 8Medical Department, HOSPITAL UNIVERSITARIO FUNDACIÓN ALCORCÓN, 9Department of Neurology, Hospital Universitario Lucus Augusti, 10Department of Neurology, Hospital San Pedro de Alcántara, 11Department of Neurology, Hospital Universitario Virgen Macarena, 12Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, 13Department of Neurology, Hospital Universitario Son Espases, 14Department of Neurology, Hospital Universitario de Albacete, 15Department of Neurology, Fundació Salut Empordà, 16Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, 17Department of Neurology, Complejo Hospitalario Universitario A Coruña, 18Department of Neurology, Hospital Arnau de Vilanova, 19Department of Neurology, Complejo Asistencial de Segovia, 20Department of Neurology, Hospital Universitario Reina Sofía
Objective:

The aim of this study was to assess the phenomenon of patients' decisional conflict regarding the choice of a disease-modifying therapy.

Background:

Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory and the variety of treatment options with different characteristics of efficacy, safety and administration.

Design/Methods:

We conducted a non-interventional, cross-sectional study at 19 hospital-based MS care units in Spain. Adult patients with a diagnosis of relapsing-remitting multiple sclerosis (RRMS) (2017 revised McDonald criteria) and disease duration between 3 and 8 years were included. Decisional conflict was measured using the 4-item Decisional Conflict Scale (SURE). A battery of patient-reported and clinician-rated measures was administered. A multivariate logistic regression analysis was conducted.

Results:

A total of 201 patients were included. Mean age (SD) was 38.7 (8.4) years and 74.1% were female. Median disease duration (IQR) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness-related uncertainty, anxiety, depressive symptoms, fatigue, symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. The treatment decisional certainty was associated with MS knowledge (OR=1.18, 95% CI 1.04, 1.33, p=0.011), self-management (OR=1.02, 95% CI 1.00, 1.04, p=0.015), lower illness uncertainty (OR=0.95, 95% CI 0.92, 0.98, p=0.002), and lower healthcare-related regret (OR=0.53, 95% CI 0.29, 0.96, p=0.035) in the multivariable analysis after adjustment for confounders.

Conclusions:

Decisional conflict regarding the choice of a disease-modifying therapy was a common phenomenon. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and encourage them to make use of psychological resources even in those who have already been through the initial stage of the disease.

10.1212/WNL.0000000000204450