Role Preferences in Treatment Decisions Among Patients with Relapsing-remitting Multiple Sclerosis
Eva Fernández-Díaz1, Elisa Salas Alonso2, Jesús Martín-Martínez3, Antonio Candeliere-Merlicco4, Francisco Barrero5, Ana Alonso Torres6, José L Sánchez-Menoyo7, Laura Borrega Canelo8, María Rodríguez-Rodríguez9, Montserrat Gómez-Gutiérrez10, Sara Eichau Madueno11, Miguel Ángel Hernández-Pérez12, Carmen Calles13, Olga Carmona14, Aida Orvíz15, Ana López-Real16, Pablo López-Muñoz17, Amelia Mendoza18, Eduardo Aguera19, Jorge Maurino2, Julia Sabin Munoz20
1Department of Neurology, Complejo Hospitalario Universitario de Albacete, 2Medical Department, Roche Farma, 3Department of Neurology, Hospital Universitario Miguel Servet, 4Department of Neurology, Hospital Rafael Méndez, 5Department of Neurology, Hospital Universitario Clínico San Cecilio, 6Department of Neurology, Hospital Regional Universitario de Málaga, 7Department of Neurology, Hospital Galdakao-Usansolo, 8Department of Neurology, 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 Universitari Son Espases, 14Department of Neurology, Fundació Salut Empordà, 15Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, 16Department of Neurology, Hospital Universitario de A Coruña, 17Department of Neurology, Hospital Arnau de Vilanova, 18Department of Neurology, Complejo Asistencial de Segovia, 19Department of Neurology, Hospital Universitario Reina Sofía, 20Department of Neurology, Hospital Universitario Puerta de Hierro
Objective:
The aim of this study was to assess relapsing-remitting multiple sclerosis (RRMS) patients’ preferred role in making treatment decisions.
Background:
Patient involvement in therapeutic decisions improves satisfaction and adherence. However, limited information is available on how patients with RRMS face the decision-making process for disease-modifying treatments.
Design/Methods:
A multicenter, non-interventional study was conducted at 19 hospital-based MS care units in Spain. Adult patients with a diagnosis of RRMS (2017 revised McDonald criteria) and disease duration between 3 and 8 years were included. Patients´ preferred role in their closest treatment decision was measured using the Control Preference Scale (CPS). A battery of patient-reported and clinician-rated measures was administered. A multivariate logistic regression analysis was conducted.
Results:
A total of 198 patients were included. Mean age (SD) was 38.7 (8.5) years and 74.2% were female. Median disease duration (IQR) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Ninety-two patients (46.5%) adopted a collaborative attitude and preferred making the treatment decision jointly with the neurologist, 59 (29.8%) adopted a passive attitude and preferred the neurologist make the decision, and 47 (23.7%) showed active attitude preferring to make the decisions themselves. We found a higher perception of symptom severity (p=0.002), more fatigue (p=0.005), a lower physical quality of life (p<0.001), and a worse mental speed processing (p=0.002) among passive patients compared to active ones. The collaborative role was associated with age (OR=1.07, 95% CI 1.01, 1.13, p=0.010) in the multivariable analysis after adjustment for confounders. There was no association between patient’ role and disability, mood, anxiety, MS knowledge, risk-taking behavior, or self-management.
Conclusions:
Although almost 50% of patients preferred a collaborative attitude in treatment decisions with their neurologists, one third preferred a passive approach. Adapting communication and participation strategies to the preferences of each RRMS patient may be crucial to improve the shared decision-making process.