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Volz T, Sippel A, Fischbach F, Richter J, Willison AG, Häußler V, Heesen C. "A second birthday"? Experiences of persons with multiple sclerosis treated with autologous hematopoietic stem cell transplantation-a qualitative interview study. Front Neurol 2024; 15:1384551. [PMID: 38751886 PMCID: PMC11094363 DOI: 10.3389/fneur.2024.1384551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction and objective Autologous hematopoietic stem cell transplantation (aHSCT) is a promising treatment option for persons with multiple sclerosis (pwMS). Patients undergoing aHSCT face unique challenges in all aspects of life. In this study, we explored the lived experiences of pwMS undergoing aHSCT. Methods Semi-structured interviews of 12 pwMS treated with aHSCT were conducted using a maximum variation sampling strategy. Interviews were transcribed verbatim and analyzed thematically using inductive and deductive categories. Results Three major themes were identified: (1) preparing for aHSCT, (2) experiencing the procedure, and (3) post-treatment time. A difficult decision-making process, organizational effort, and funding difficulties characterized the preparation for transplantation. AHSCT was seen as a life-changing event accompanied by both psychological and physical stress, with an associated feeling of regaining control. The transplantation had a lasting positive effect on the lives of the interviewed pwMS. However, the early post-treatment time was characterized by successes and failures alike. Particularly the independently organized medical aftercare was perceived as challenging. Retrospective revaluation has led most pwMS to wish for earlier information provision about the treatment option of aHSCT during their treatment history. Conclusion AHSCT had a clear impact on patients' physical and psycho-social health, influencing their perception of life and its quality. Assessing and attending to unmet needs of patients before, during, and after transplantation may positively influence their experience of aHSCT.
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Affiliation(s)
- Timo Volz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Felix Fischbach
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Johanna Richter
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alice Grizzel Willison
- Department of Neurology, Medical Faculty University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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2
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Hrušková N, Berchová Bímová K, Davies Smith A, Škodová T, Bičíková M, Kolátorová L, Štětkářová I, Brožek Ľ, Javůrková A, Angelová G, Řasová K. People with newly diagnosed multiple sclerosis benefit from a complex preventative intervention-a single group prospective study with follow up. Front Neurol 2024; 15:1373401. [PMID: 38660088 PMCID: PMC11039797 DOI: 10.3389/fneur.2024.1373401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Newly diagnosed people with multiple sclerosis frequently report fatigue, pain, depression and anxiety. Preventative programmes may be beneficial, but there is limited evidence of their effectiveness, especially long-term follow-up. Methods The programme consisted of 6-month face to face intervention (an introductory workshop, psychology-led group sessions and individual physical therapy) followed by 6-month self-guided therapy. Outcome measures were taken at baseline, 6 and 12 months. Primary outcomes measures were self-report questionnaires for fatigue, satisfaction with life and disease acceptance. Secondary outcomes were spirometry, spiroergometric parameters and neuroactive steroid levels. Results From 22 participants enrolled, 17 completed the first 6 months and 13 the follow-up. Fatigue measured on the Fatigue scale for motor and cognitive functions decreased significantly at 6 months (p = 0.035) and at follow-up (p = 0.007). The Modified Fatigue Impact Scale (p = 0.035) and Satisfaction With Life Scale (p = 0.007) significantly increased at follow-up. Spirometry, spiroergometric parameters, steroid hormones and neuroactive steroids levels did not change significantly. Conclusion This programme reduces fatigue and improves satisfaction with life in this patient group with improvements sustained at 12 months. People who participated more frequently showed greater benefit. Clinical rehabilitation impact The paper describes the effects of a complex preventative intervention for people with newly diagnosed Multiple Sclerosis. The study found that this programme reduces fatigue and improves satisfaction with life with long-term benefit (at 12-month follow up). The individuals who participated less frequently experienced fewer benefits.
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Affiliation(s)
- Natália Hrušková
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Berchová Bímová
- Department of Applied Ecology, Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czechia
| | - Angela Davies Smith
- MS Research, Treatment and Education, The Vassall Centre, Bristol, United Kingdom
| | - Tereza Škodová
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Marie Bičíková
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Lucie Kolátorová
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czechia
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Ľuba Brožek
- Mediterra s.r.o., Malvazinky Rehabilitation Clinic, Prague, Czechia
| | - Alena Javůrková
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Gabriela Angelová
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Kamila Řasová
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czechia
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3
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Stoll S, Costello K, Newsome SD, Schmidt H, Sullivan AB, Hendin B. Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review. Neurol Ther 2024; 13:21-37. [PMID: 38180727 PMCID: PMC10787702 DOI: 10.1007/s40120-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Shared decision-making (SDM) between the patient and their healthcare provider (HCP) in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. In multiple sclerosis (MS), SDM is particularly crucial for optimizing treatment in a landscape that has grown more complex with the availability of newer, high-efficacy MS therapies. However, little direct evidence on the effectiveness of SDM is available to guide practice. Multiple factors, including patient age, ethnic background, perceptions, invisible MS symptoms, and psychological comorbidities can influence a patient's willingness and ability to participate in SDM. HCPs need to appreciate these factors and ask the right questions to break down obstacles to SDM. The HCP has a responsibility to help patients feel adequately informed and comfortable in having an active role in their care. This review identifies potential barriers to SDM and provides a strategy for HCPs to overcome these obstacles through patient (and caregiver) discussions to ensure optimal patient satisfaction with treatment and thus the best possible outcomes for their patients.
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Affiliation(s)
| | | | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hollie Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA
| | - Amy B Sullivan
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Barry Hendin
- Integrated Multiple Sclerosis Center, Phoenix, AZ, USA
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4
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Greene B, Bernardo L, Thompson M, Loughead J, Ashare R. Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial. JMIR Form Res 2023; 7:e47121. [PMID: 37477975 PMCID: PMC10403799 DOI: 10.2196/47121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. OBJECTIVE This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. METHODS A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 "draws" from a bowl containing 500 "chips" valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, "Many find it a rewarding way to advance science and be part of a community") were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. RESULTS Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). CONCLUSIONS Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials.
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Affiliation(s)
- Brittney Greene
- State University of New York at Buffalo, Buffalo, NY, United States
| | - Leah Bernardo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Morgan Thompson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - James Loughead
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Ashare
- State University of New York at Buffalo, Buffalo, NY, United States
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5
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Sippel A, Riemann-Lorenz K, Pöttgen J, Wiedemann R, Drixler K, Bitzer EM, Holmberg C, Lezius S, Heesen C. Validation of the German eHealth impact questionnaire for online health information users affected by multiple sclerosis. BMC Med Inform Decis Mak 2022; 22:219. [PMID: 35974395 PMCID: PMC9380659 DOI: 10.1186/s12911-022-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Persons with multiple sclerosis (MS) are confronted by an overwhelming amount of online health information, which can be valuable but also vary in quality and aim. Therefore, it is of great importance for developers and providers of eHealth information to understand its impact on the users. The eHealth Impact Questionnaire (eHIQ) has been developed in the United Kingdom to measure the potential effects of health and experimental information websites. This contains user’s general attitudes towards using the internet to gain health information and attitudes towards a specific health related website. The self-complete questionnaire is divided into two independently administered and scored parts: the 11-item eHIQ part 1 and the 26-item eHIQ part 2. This study aimed to validate the psychometric properties of the German version of the eHealth Impact Questionnaire (eHIQ-G). Methods 162 people with multiple sclerosis browsed one of two possible websites containing information on MS and completed an online survey. Internal consistency was assessed by Cronbach’s alpha and structural validity by Confirmatory Factor Analysis. Construct validity was examined by assessing correlations with the reference instruments eHealth Literacy Questionnaire and the General Self-Efficacy Scale measuring related, but dissimilar constructs. Moreover, we investigated the mean difference of the eHIQ-G score between the two websites. Data were analyzed using SPSS and AMOS software. Results The eHIQ-G subscales showed high internal consistency with Cronbach’s alpha from 0.833 to 0.885. The 2-factor model of eHIQ part 1 achieved acceptable levels of goodness-of-fit indices, whereas the fit for the 3-factor model of eHIQ part 2 was poor and likewise for the alternative modified models. The correlations with the reference instruments were 0.08–0.62 and as expected. Older age was related with lower eHIQ part 1 score, whereas no significant effect was found for education on eHIQ part 1. Although not significant, the website ‘AMSEL’ reached higher mean scores on eHIQ part 2. Conclusions The eHIQ-G has good internal consistency, and sufficient structural and construct validity. This instrument will facilitate the measurement of the potential impact of eHealth tools. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01968-6.
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Affiliation(s)
- Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Development and evaluation of a website with patients experiences of multiple sclerosis: a mixed methods study. BMC Neurol 2022; 22:146. [PMID: 35443631 PMCID: PMC9019288 DOI: 10.1186/s12883-022-02663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. METHODS A mixed-methods approach was applied. A total of 69 participants visited the German "Patient Experiences with MS (PExMS)" website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people's experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. CONCLUSIONS The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.
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7
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Higueras Y, Salas E, Meca-Lallana V, Carrascal Rueda P, Rodríguez De la Fuente O, Cabello-Moruno R, Maurino J, Ruiz Díaz MÁ. Information-Seeking Strategies of People with Multiple Sclerosis in Spain: The INFOSEEK-MS Study. Patient Prefer Adherence 2022; 16:51-60. [PMID: 35046641 PMCID: PMC8762518 DOI: 10.2147/ppa.s344690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Patients with multiple sclerosis (MS) are increasingly demanding access to reliable information regarding their disease. The objective of the INFOSEEK-MS study was to assess what are the strategies people with MS use when searching for information on their disease, including sources, frequency, reliability, and preferred content. PATIENTS AND METHODS A non-interventional, cross-sectional study was conducted. Patients with a diagnosis of MS according to the 2010 McDonald criteria were included. The InfoSeek questionnaire was used to assess patients' strategies when seeking information about the disease. Clinical characteristics and other variables, including disability, quality of life, fatigue, cognition, anxiety and depression, were analysed using the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), 5-item Modified Fatigue Scale (MFIS-5), Symbol Digit Modalities Test (SDMT), and Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS Three hundred and two patients were studied (mean age: 42.3 ± 10 years, 64% female, mean disease duration: 9.6 ± 7.0 years, 90% with relapsing-remitting MS, and mean EDSS score: 2.6 ± 1.9). The internet (either via mobile or computer) is a frequently reported source of information. Lifestyle-related information (67.2%), research and emerging treatments (63.6%), symptom control (49.7%), sharing experiences with other patients (46.4%), and disease prognosis (46.4%) were the most searched topics. Neurologists and nurses were the most trusted source of information. Younger patients and higher SDMT scores were associated with all search resources (M = 37.7 and M = 49.97, respectively). The frequency of searches was related to the number of relapses (R2 = 0.07), EDSS (R2 = 0.14), MSIS-29 physical and psychological components (R2 = 0.132) and inversely with depression (R2 = 0.132). CONCLUSION Although healthcare professionals are considered the most reliable source of information for people with MS, searching for information on the Internet is very frequent. An individualized information strategy considering the different factors involved is needed.
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Affiliation(s)
- Yolanda Higueras
- Department of Neurology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elisa Salas
- Medical Department, Roche Pharma, Madrid, Spain
- Correspondence: Elisa Salas Medical Department, Roche Pharma, Calle Ribera del Loira, 50, Madrid, 28042, SpainTel +34 913248173 Email
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8
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Sippel A, Riemann-Lorenz K, Scheiderbauer J, Kleiter I, Morrison R, Kofahl C, Heesen C. Patients experiences with multiple sclerosis disease-modifying therapies in daily life - a qualitative interview study. BMC Health Serv Res 2021; 21:1141. [PMID: 34686166 PMCID: PMC8539738 DOI: 10.1186/s12913-021-07012-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/07/2021] [Indexed: 01/26/2023] Open
Abstract
Background Besides coping with a disease with many uncertainties, people with relapsing-remitting multiple sclerosis face complex decisions concerning disease-modifying therapies (DMTs). In an interview study, we aimed to assess patients’ experiences with DMTs. Methods Problem-centred interviews were conducted with 50 people with relapsing-remitting multiple sclerosis in Germany using maximum variation sampling and covering all licensed DMTs. Data were analysed thematically using deductive and inductive categories. Results 47 of 50 patients had treatment with at least one of the approved DMTs. The main themes were: (1) starting a DMT, (2) switching to another DMT, (3) discontinuing a DMT, and (4) multiple sclerosis without starting a DMT. Different intercorrelated factors influenced the decision-making processes for or against a DMT. Individual experiences with DMTs in daily life contained the effort in administration, success, and failure of DMTs, coping strategies and well-being without DMTs. The decision-making process for or against a DMT and the use of those treatments can be understood as a constant, continually shifting process, complicated by different factors, which change over time. Experiences with DMTs were characterized by attempts to handle uncertainty and to (re)gain control and integrate adaptivity into one’s life. Conclusions The study provides a rich and nuanced amount of patients’ experiences with DMTs. The findings demonstrate the importance for practitioners to look at current life circumstances of patients with multiple sclerosis when recommending a DMT and to promote and enable patients to make informed decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07012-z.
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Affiliation(s)
- Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - Christopher Kofahl
- Patient representative, Trier, Hamburg, Germany.,Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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9
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Alegiani AC, Rahn AC, Steckelberg A, Thomalla G, Heesen C, Köpke S. Quality of Stroke Patient Information Applied in Randomized Controlled Trials-Literature Review. Front Neurol 2020; 11:526515. [PMID: 33365010 PMCID: PMC7750452 DOI: 10.3389/fneur.2020.526515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Strokes have a huge impact on patients' quality of life. Although there are potentially effective secondary preventions and treatment options for stroke patients, adherence is mostly low. Low disease and treatment-related knowledge and, consequently, a lack of informed decision-making in stroke patients may contribute to this problem. However, stroke patient information did not seem to have relevant effects on patients' knowledge in randomized controlled trials. One contributing factor may be the lack of thoroughly developed patient information materials. Methods: We aimed to evaluate the quality of patient information materials for stroke patients by using randomized controlled trials, applying quality criteria for evidence-based patient information (EBPI). We conducted a literature search (MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL). To be included in the review, research had to be randomized controlled trials that provided stroke patient information, were published in English, and had knowledge assessed as the primary endpoint. Authors of primary studies were contacted and asked for information materials applied. Results: We screened 15,507 hits and identified 30 eligible studies. Information materials were available for only eight studies. Analyses revealed that all available materials had important shortcomings concerning EBPI quality criteria [concerning, for example, structural information (e.g., reporting conflicts of interest), content information (e.g., reporting sources of information), or comprehensive descriptions of treatment effects and side effects]. Frequently, treatment effects were reported only narratively without providing absolute numbers, values, or frequencies. Conclusion: Quality of materials differed, but none sufficiently fulfilled EBPI quality criteria. Unsatisfactory trial results concerning patient knowledge and patient involvement in decision-making may at least partially be explained by limitations of the provided materials. Future patient information should consider EBPI quality criteria.
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Affiliation(s)
- Anna C Alegiani
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne C Rahn
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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10
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Col N, Alvarez E, Springmann V, Ionete C, Berrios Morales I, Solomon A, Kutz C, Griffin C, Tierman B, Livingston T, Patel M, van Leeuwen D, Ngo L, Pbert L. A Novel Tool to Improve Shared Decision Making and Adherence in Multiple Sclerosis: Development and Preliminary Testing. MDM Policy Pract 2019; 4:2381468319879134. [PMID: 31667351 PMCID: PMC6798166 DOI: 10.1177/2381468319879134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 08/29/2019] [Indexed: 01/18/2023] Open
Abstract
Background. Most people with multiple sclerosis (MS) want to be
involved in medical decision making about disease-modifying therapies (DMTs),
but new approaches are needed to overcome barriers to participation.
Objectives. We sought to develop a shared decision-making
(SDM) tool for MS DMTs, evaluate patient and provider responses to the tool, and
address challenges encountered during development to guide a future trial.
Methods. We created a patient-centered design process
informed by image theory to develop the MS-SUPPORT SDM tool. Development
included semistructured interviews and alpha and beta testing with MS patients
and providers. Beta testing assessed dissemination and clinical integration
strategies, decision-making processes, communication, and adherence. Patients
evaluated the tool before and after a clinic visit. Results.
MS-SUPPORT combines self-assessment with tailored feedback to help patients
identify their treatment goals and preferences, correct misperceptions, frame
decisions, and promote adherence. MS-SUPPORT generates a personal summary of
their responses that patients can share with their provider to facilitate
communication. Alpha testing (14 patients) identified areas needing improvement,
resulting in reorganization and shortening of the tool. MS-SUPPORT was highly
rated in beta testing (15 patients, 4 providers) on patient-provider
communication, patient preparation, adherence, and other endpoints.
Dissemination through both patient and provider networks appeared feasible. All
patient testers wanted to share the summary report with their provider, but only
60% did. Limitations. Small sample size, no comparison group.
Conclusions. The development process resulted in a
patient-centered SDM tool for MS that may facilitate patient involvement in
decision making, help providers understand their patients’ preferences, and
improve adherence, though further testing is needed. Beta testing in real-world
conditions was critical to prepare the tool for future testing and inform the
design of future studies.
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Affiliation(s)
- Nananda Col
- Shared Decision Making Resources, Georgetown, Maine
| | | | | | - Carolina Ionete
- University of Massachusetts Memorial Health Care, Worchester, Massachusetts
| | | | | | - Christen Kutz
- Colorado Springs Neurological Associates, Colorado Springs, Colorado
| | | | | | | | | | | | - Long Ngo
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lori Pbert
- University of Massachusetts Medical School, Worchester, Massachusetts
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11
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Ravyn D, Goodwin B, Lowney R. Continuous learning in multiple sclerosis care: a qualitative study of the expanded learning model for systems. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:122-128. [PMID: 31256072 PMCID: PMC6766394 DOI: 10.5116/ijme.5cfa.29cb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study characterized how an online continuing education activity affected knowledge, attitudes, and practices of healthcare professionals who care for patients with multiple sclerosis (MS) and whether those changes reflected theorized translational mechanisms proposed in The Expanded Learning Model for Systems (TELMS). METHODS This preliminary study used semi-structured interviews (thematic analysis) to assess whether and how translational mechanisms underpinning the TELMS theory might be revealed in learners' attitudes and practice behavior. Eighteen participants (primarily neurologists and nurses) were interviewed by telephone or online. Thematic analysis identified relevant themes according to sensitizing concepts derived from TELMS and the recognition of emergent themes. RESULTS Textual interpretation of interview data revealed that MS providers act in various scenarios that validate the principles of TELMS model of learning engagement. Further, elements of translational mechanisms proposed by TELMS were consistently observed in the narrative reflections. Emergent themes included the importance of practices such as goal setting, coordination of care, systems-level MS care, and economic considerations. Practitioners particularly drew on ideas from TELMS when facing challenges in diverse cultural and sociocultural settings. CONCLUSIONS We identified mechanisms of change reflected in the TELMS model that is useful for the design and evaluation of future educational activities. These include attitudes and beliefs about the application of evidence-aligned MS care, as well as the commitment to multidisciplinary strategies, enhanced coordination of care, and promotion of systems-based changes. Future studies are needed to further validate the TELMS model.
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Affiliation(s)
- Dana Ravyn
- CMEology, West Hartford, Connecticut, USA
| | | | - Rob Lowney
- CMEology, West Hartford, Connecticut, USA
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12
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Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 1:CD012732. [PMID: 30637728 PMCID: PMC6353175 DOI: 10.1002/14651858.cd012732.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation. OBJECTIVES To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes, and to highlight current gaps in knowledge. METHODS We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework. MAIN RESULTS Overall, we included 15 reviews published in the Cochrane Library, comprising 164 randomised controlled trials (RCTs) and four controlled clinical trials, with a total of 10,396 participants. The included reviews evaluated a wide range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy (HBOT), whole-body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. We assessed all reviews to be of high to moderate methodological quality, based on R-AMSTAR criteria.Moderate-quality evidence suggested that physical therapeutic modalities (exercise and physical activities) improved functional outcomes (mobility, muscular strength), reduced impairment (fatigue), and improved participation (quality of life). Moderate-quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation, and interventions that provided information improved patient knowledge. Low-qualitty evidence suggested that neuropsychological interventions, symptom-management programmes (spasticity), whole body vibration, and telerehabilitation improved some patient outcomes. Evidence for other rehabilitation modalities was inconclusive, due to lack of robust studies. AUTHORS' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit, although the certainty of evidence varies across the different types of interventions evaluated by the reviews. Structured, multidisciplinary rehabilitation programmes and physical therapy (exercise or physical activities) can improve functional outcomes (mobility, muscle strength, aerobic capacity), and quality of life. Overall, the evidence for many rehabilitation interventions should be interpreted cautiously, as the majority of included reviews did not include data from current studies. More studies, with appropriate design, which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge.
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Affiliation(s)
- Bhasker Amatya
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Mary Galea
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
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13
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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14
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Ben-Zacharia A, Adamson M, Boyd A, Hardeman P, Smrtka J, Walker B, Walker T. Impact of Shared Decision Making on Disease-Modifying Drug Adherence in Multiple Sclerosis. Int J MS Care 2018; 20:287-297. [PMID: 30568566 PMCID: PMC6295876 DOI: 10.7224/1537-2073.2017-070] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shared decision making (SDM) and adherence to treatment are an integral part of multiple sclerosis (MS) care. A collaborative process, SDM actively involves the patient, the health care provider, and an extended network in making treatment decisions. Adherence to disease-modifying drug therapies in patients with MS presents an ongoing challenge for patients and health care providers due to the chronic nature of this disease. This narrative review aims to explore the impact of SDM on adherence based on existing literature and to identify new approaches to optimizing adherence. METHODS A search was conducted using medical subject heading terms, including decision-making, adherence, shared decision-making, compliance, and patient-centered care. RESULTS Shared decision making between patients and clinicians promotes adherence to the treatment plan in MS. A proactive SDM approach is based on patient preferences, education, and engagement. Providing credible and accurate sources of information is essential for improving patient engagement. Home monitoring, computerized models, and active patient engagement are a few new approaches to improve adherence in patients with MS. CONCLUSIONS Shared decision-making interventions can have a positive effect on patient adherence to disease-modifying drug therapy in MS care. A range of new strategies is emerging that may help promote optimal disease management.
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15
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Heesen C, Rahn AC. Guest Editorial: Shared Decision Making in Managing Multiple Sclerosis: Revisiting the Research Agenda. Int J MS Care 2018; 20:v-vi. [PMID: 30568569 DOI: 10.7224/1537-2073.2018-098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Köpke S, Solari A, Rahn A, Khan F, Heesen C, Giordano A. Information provision for people with multiple sclerosis. Cochrane Database Syst Rev 2018; 10:CD008757. [PMID: 30317542 PMCID: PMC6517040 DOI: 10.1002/14651858.cd008757.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. These include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies, and non-pharmacological interventions, among others. While people with MS demand adequate information to be able to actively participate in medical decision making and to self manage their disease, it has been shown that patients' disease-related knowledge is poor, therefore guidelines recommend clear and concise high-quality information at all stages of the disease. Several studies have outlined communication and information deficits in the care of people with MS. However, only a few information and decision support programmes have been published. OBJECTIVES The primary objectives of this updated review was to evaluate the effectiveness of information provision interventions for people with MS that aim to promote informed choice and improve patient-relevant outcomes, Further objectives were to evaluate the components and the developmental processes of the complex interventions used, to highlight the quantity and the certainty of the research evidence available, and to set an agenda for future research. SEARCH METHODS For this update, we searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register, which contains trials from CENTRAL (the Cochrane Library 2017, Issue 11), MEDLINE, Embase, CINAHL, LILACS, PEDro, and clinical trials registries (29 November 2017) as well as other sources. We also searched reference lists of identified articles and contacted trialists. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-randomised controlled trials, and quasi-randomised trials comparing information provision for people with MS or suspected MS (intervention groups) with usual care or other types of information provision (control groups) were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed the risk of selection bias, performance bias, attrition bias, and detection bias. We contacted authors of relevant studies for additional information. MAIN RESULTS We identified one new RCT (73 participants), which when added to the 10 previously included RCTs resulted in a total of 11 RCTs that met the inclusion criteria and were analysed (1387 participants overall; mean age, range: 31 to 51; percentage women, range: 63% to 100%; percentage relapsing-remitting MS course, range: 45% to 100%). The interventions addressed a variety of topics using different approaches for information provision in different settings. Topics included disease-modifying therapy, relapse management, self care strategies, fatigue management, family planning, and general health promotion. The active intervention components included decision aids, decision coaching, educational programmes, self care programmes, and personal interviews with physicians. All studies used one or more components, but the number and extent differed markedly between studies. The studies had a variable risk of bias. We did not perform meta-analyses due to marked clinical heterogeneity. All five studies assessing MS-related knowledge (505 participants; moderate-certainty evidence) detected significant differences between groups as a result of the interventions, indicating that information provision may successfully increase participants' knowledge. There were mixed results on decision making (five studies, 793 participants; low-certainty evidence) and quality of life (six studies, 671 participants; low-certainty evidence). No adverse events were detected in the seven studies reporting this outcome. AUTHORS' CONCLUSIONS Information provision for people with MS seems to increase disease-related knowledge, with less clear results on decision making and quality of life. The included studies in this review reported no negative side effects of providing disease-related information to people with MS. Interpretation of study results remains challenging due to the marked heterogeneity of interventions and outcome measures.
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Affiliation(s)
- Sascha Köpke
- University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyRatzeburger Allee 160LübeckGermanyD‐23538
| | - Alessandra Solari
- Fondazione I.R.C.C.S. ‐ Neurological Institute Carlo BestaNeuroepidemiology UnitVia Celoria 11MilanItaly20133
| | - Anne Rahn
- University Medical CenterInstitute of Neuroimmunology and Multiple SclerosisMartinistr 52HamburgGermany20246
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Christoph Heesen
- University Medical CenterInstitute of Neuroimmunology and Multiple SclerosisMartinistr 52HamburgGermany20246
| | - Andrea Giordano
- Fondazione I.R.C.C.S. ‐ Neurological Institute Carlo BestaNeuroepidemiology UnitVia Celoria 11MilanItaly20133
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17
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Synnot AJ, Hawkins M, Merner BA, Summers MP, Filippini G, Osborne RH, Shapland SD, Cherry CL, Stuckey R, Milne CA, Mosconi P, Colombo C, Hill SJ. Producing an evidence-based treatment information website in partnership with people affected by multiple sclerosis. Health Sci Rep 2018; 1:e24. [PMID: 30623063 PMCID: PMC6266475 DOI: 10.1002/hsr2.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIMS In earlier work, we identified that people affected by multiple sclerosis (MS) can have difficulty finding online treatment information that is up to date, trustworthy, understandable, and applicable to personal circumstances, but does not provoke confusion or negative emotional consequences. The objective was to develop online consumer summaries of MS treatment evidence (derived from Cochrane Reviews) that respond to identified treatment information needs of people affected by MS. METHODS A 2-phase mixed-methods project, conducted in partnership with consumers and an MS organisation. Phase 1 included review panels with consumers (Australians affected by MS) and health professionals to test paper-based treatment summaries before development, and pilot testing of the website. Phase 2 involved an online survey after website launch. RESULTS Eighty-three participants (85% affected by MS) took part. Phase 1 participants strongly endorsed key review summary components, including layering information, and additional sections to aid personal applicability. Participants additionally suggested questions for health professionals. Participants across both phases were receptive to the idea of being provided with Cochrane Review summaries online but were seeking other types of evidence and information, such as personal experiences and the latest experimental treatments, which could not be provided. While the small survey sample size (n = 58) limits application of the results to a broader population, the website was viewed favourably, as a useful, understandable, and trustworthy information source. CONCLUSION We describe a partnership approach to developing online evidence-based treatment information, underpinned by an in-depth understanding of consumers' information needs.
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Affiliation(s)
- Anneliese J. Synnot
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
- Cochrane Australia, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Melanie Hawkins
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social DevelopmentDeakin UniversityGeelongAustralia
| | - Bronwen A. Merner
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Michael P. Summers
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Graziella Filippini
- Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group, Scientific DirectionIRCCS Foundation Neurological Institute Carlo BestaMilanItaly
| | - Richard H. Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social DevelopmentDeakin UniversityGeelongAustralia
| | | | - Catherine L. Cherry
- Burnet Institute, Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Catherine A. Milne
- Centre for Values, Ethics and Law in MedicineUniversity of SydneySydneyNew South WalesAustralia
| | - Paola Mosconi
- Laboratory for Medical Research and Consumer Involvement, Department of Public HealthIRCCS Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
| | - Cinzia Colombo
- Laboratory for Medical Research and Consumer Involvement, Department of Public HealthIRCCS Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
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18
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Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Patient Education. Neurol Ther 2017; 7:23-36. [PMID: 29243028 PMCID: PMC5990508 DOI: 10.1007/s40120-017-0087-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 11/20/2022] Open
Abstract
A diagnosis of multiple sclerosis (MS) is life-altering. Because the course of MS is heterogeneous, patients may face uncertainty in terms of long-term physical and cognitive challenges, potential loss of employment, and the risk of social isolation. Patients often turn to the Internet and social media for information about MS and its management, and to seek out fellow patients and support groups. Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient education. We consider the access that these conduits provide not only to other patients with MS but also to a wealth of disease-related information online. These themes are further illustrated with first-hand experiences of the patient author and her physician. We also explore the impact of the Internet and social media on the education and support of patients with MS from the healthcare professional’s (HCP’s) perspective, including opportunities for HCPs to promote disease education among their patients, and the advantages that arise from patients being better informed about their disease. The rise of the Internet and social media has changed the patient experience, helping patients to support each other, to educate themselves proactively about their condition, and to participate more actively in decisions relating to disease management than perhaps was the case historically. Funding Novartis Pharmaceuticals Corporation.
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19
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Sustersic M, Gauchet A, Foote A, Bosson J. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expect 2017; 20:531-542. [PMID: 27669682 PMCID: PMC5512995 DOI: 10.1111/hex.12487] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. OBJECTIVE To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. METHODOLOGY We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. RESULTS Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. DISCUSSION Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. CONCLUSION PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.
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Affiliation(s)
- Mélanie Sustersic
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Groupe Hospitalier Mutualiste de Grenoble (GHM)GrenobleFrance
| | - Aurélie Gauchet
- LIP/LPC2S, EA 4145University of Grenoble AlpesGrenobleFrance
| | - Alison Foote
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
| | - Jean‐Luc Bosson
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
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20
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Burkill S, Montgomery S, Hajiebrahimi M, Hillert J, Olsson T, Bahmanyar S. Mortality trends for multiple sclerosis patients in Sweden from 1968 to 2012. Neurology 2017; 89:555-562. [PMID: 28687718 DOI: 10.1212/wnl.0000000000004216] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/15/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess trends in mortality and causes of death for patients with multiple sclerosis (MS) relative to those without MS in Sweden. METHODS Patients with an MS diagnosis in Sweden between 1964 and 2012 were identified with the Patient Register and the Multiple Sclerosis Register. For this cohort study, each patient with MS (n = 29,617) was matched with 10 individuals without MS (n = 296,164) on sex, year of birth, vital status, and region of residence at the time of MS diagnosis with the Total Population Register. The Causes of Death Register was used to identify causes of death. Cox proportional hazard models were constructed to assess whether risk of mortality was increased for patients with MS. RESULTS The hazard ratio (HR) for patients with MS was 2.92 (95% confidence interval [CI] 2.86-2.99) for all-cause mortality over the entire study period. The largest differences between the cohorts were death resulting from respiratory (HR 5.07, 95% CI 4.87-5.26) and infectious (HR 4.07, 95% CI 3.70-4.47) diseases. Overall and for each specific cause, there have been improvements for the MS group and a subsequent reduction in the HR. The HR decreased from 6.52 (95% CI 5.79-7.34) for the period of 1968 to 1980 to 2.08 (95% CI 1.95-2.22) for the time period of 2001 to 2012. An interaction between time period and MS exposure showed that the decrease in mortality over time was statistically significant, with a larger decrease for patients with MS than their matched comparators. CONCLUSIONS There has been a substantial improvement in mortality overall and for each specified cause of death for patients with MS compared with individuals without MS; however, large differences still remain.
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Affiliation(s)
- Sarah Burkill
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran.
| | - Scott Montgomery
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran
| | - MohammadHossein Hajiebrahimi
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran
| | - Jan Hillert
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran
| | - Tomas Olsson
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran
| | - Shahram Bahmanyar
- From the Clinical Epidemiology Unit (S.B., S.M., M.H., S.B) and Centre for Pharmacoepidemiology (S.B., S.B.), Department of Medicine, Solna, Karolinska Institutet, Stockholm; Clinical Epidemiology and Biostatistics (S.M.), School of Medical Sciences, Örebro University, Sweden; Department of Epidemiology and Public Health (S.M.), University College London, UK; Division of Neurology (J.H.) and Neuroimmunology Unit (T.O.), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Biostatistics and Epidemiology Unit (M.H., S.B.), Health Faculty, Golestan University of Medical Sciences, Golestan, Iran
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21
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Ploughman M, Collins K, Wallack EM, Monks M, Mayo N. Women's and Men's Differing Experiences of Health, Lifestyle, and Aging with Multiple Sclerosis. Int J MS Care 2017; 19:165-171. [PMID: 28835740 DOI: 10.7224/1537-2073.2016-014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The growing population of older people with multiple sclerosis (MS) has led to more interest in understanding factors associated with healthy aging. We aimed to determine whether older women and men with MS have different health and lifestyle behaviors and whether there are sex differences in contributors to perceived health. METHODS Data were obtained from a postal survey involving 743 Canadians older than 55 years with MS for at least 20 years. Sex differences in health, lifestyle, mood, and socioeconomics were examined using analysis of variance. Multiple regression was used to build explanatory models of health perception. RESULTS Despite no differences in age, years with MS, disability, fatigue, or social support, older men (n = 166) experienced lower perceived health and lower resilience and participated less in life roles than older women (n = 577). Men experienced more depressive symptoms, and women reported more anxiety. Depression was the strongest predictor of health perception in both women and men (β = -2.40 and -5.19, respectively, for each 3-point increase in depressive symptoms). Other contributors included household participation, fatigue, resilience, and disability in women and physical activity, financial flexibility, and alcohol use in men. CONCLUSIONS Older men exhibit poorer adaptation to aging with MS than older women.
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22
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Guéguen A, Maillart E, Gallice T, Allaf B. Evaluation of French-language internet sites dealing with multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 2:2055217316652419. [PMID: 28607728 PMCID: PMC5433325 DOI: 10.1177/2055217316652419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/04/2016] [Indexed: 12/05/2022] Open
Abstract
Background Information available on the internet has changed patient–neurologist relationships.
Its evaluation for multiple sclerosis is only partial, regardless of the language
used. Objective We aim to evaluate the content quality and ranking indexes of French-language sites
dealing with multiple sclerosis. Methods Two French terms and three search engines were used to identify the sites whose ranking
indexes were calculated according to their positions on each page designated by the
search engines. Three evaluators used the DISCERN questionnaire to assess the content
quality of the 25 selected sites. The sites were classified according to the mean of the
evaluators’ grades. Grading agreement between evaluators was calculated. Ranking indexes
were computed as a rank/100. Results Content level was deemed mediocre, with poor referencing of the information provided.
The naïve and two expert evaluators’ grades differed. Content quality disparity was
found within the different website categories, except for institutional sites. No
correlation was found between content quality and ranking index. Conclusion The information available was heterogeneous. Physicians should guide patients in their
internet searches for information so that they can benefit from good-quality input which
is potentially able to improve their management.
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Affiliation(s)
- Antoine Guéguen
- Service de Neurologie, Fondation Ophtalmologique A. de Rothschild, Paris, France
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23
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Reen GK, Silber E, Langdon DW. Interventions to support risk and benefit understanding of disease-modifying drugs in Multiple Sclerosis patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1031-1048. [PMID: 28108125 DOI: 10.1016/j.pec.2016.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/29/2016] [Accepted: 12/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The present review evaluates interventions that have been designed to improve understanding of the complex risk-benefit profiles of disease-modifying drugs (DMDs) in patients with Multiple Sclerosis (MS). METHODS A systematic search conducted using PubMed, Embase, Google Scholar and PsycINFO identified 15 studies. Interventions which provided treatment information were present across a range of study designs. A narrative synthesis was conducted due to heterogeneity of research findings. RESULTS Interventions providing treatment information ranged from comprehensive education programmes to booklets of a few pages. MS patients favoured the interventions they received. Understanding of overall treatment information and treatment risks specifically, generally improved following interventions. Yet overestimation of treatment benefits persisted. There was no conclusive effect on DMD decisions. No superior intervention was identified. CONCLUSION Interventions designed to improve understanding of DMD risk and benefit information are moderately successful. PRACTICE IMPLICATIONS Additional support provided to MS patients beyond routine healthcare can generally improve understanding of the complex risk-benefit profiles of DMDs. Future interventions need to ensure that patients with symptoms that may confound understanding can also benefit from this additional information.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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24
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Bakker C, Stephenson C, Stephenson E, Chaves D. Public Funding and Open Access to Research: A Review of Canadian Multiple Sclerosis Research. J Med Internet Res 2017; 19:e52. [PMID: 28242594 PMCID: PMC5348618 DOI: 10.2196/jmir.6250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 01/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background Multiple sclerosis (MS), a progressive demyelinating disease of the brain and spinal cord, is the leading cause of nontraumatic neurological damage in young adults. Canada has one of the highest reported incidents of MS, with estimates between 55 and 240 per 100,000 individuals. Between 2009 and 2014, the MS Society of Canada provided over Can $90 million to researchers and, since 2013, has encouraged researchers to make both current and previous research products openly available. Objective The goal of the study was to determine the open access (OA) cost implications and repository policies of journals frequently used by a sample of MS researchers. This study benchmarked current publishing preferences by MS Society of Canada researchers by examining the OA full-text availability of journal articles written by researchers funded between 2009 and 2014. Methods Researchers were identified from the 2009 to 2014 annual MS Society of Canada Research Summaries. Articles were identified through searches in Web of Science, Scopus, Medline and Embase (both via OVID). Journal level analysis included comparison of OA policies, including article processing charges (APCs) and repository policies. Data were analyzed using descriptive statistics. Results There were 758 articles analyzed in this study, of which 288 (38.0%) were OA articles. The majority of authors were still relying on journal policies for deposit in PubMed Central or availability on publisher websites for OA. Gold OA journals accounted for 10.2% of the journals in this study and were associated with significantly lower APCs (US $1900) than in hybrid journals (US $3000). Review of the journal self-archiving options highlighted the complexity of stipulations that authors would have to navigate to legally deposit a version of their article. Conclusions This study found that there are currently researcher- and publisher-imposed barriers to both the gold and green roads to OA. These results provide a current benchmark against which efforts to enhance openness can be measured and can serve as a reference point in future assessments of the impact of OA policies within this field. With funding agencies worldwide releasing OA mandates, future success in compliance will require changes to how researchers and publishers approach production and dissemination of research.
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Affiliation(s)
- Caitlin Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Carol Stephenson
- Council of Prairie and Pacific University Libraries, Vancouver, BC, Canada
| | - Erin Stephenson
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Debbie Chaves
- Library, Wilfrid Laurier University, Waterloo, ON, Canada
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25
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Gay MC, Bungener C, Thomas S, Vrignaud P, Thomas PW, Baker R, Montel S, Heinzlef O, Papeix C, Assouad R, Montreuil M. Anxiety, emotional processing and depression in people with multiple sclerosis. BMC Neurol 2017; 17:43. [PMID: 28231828 PMCID: PMC5324294 DOI: 10.1186/s12883-017-0803-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high comorbidity of anxiety and depression in people with multiple sclerosis (MS), little is known about their inter-relationships. Both involve emotional perturbations and the way in which emotions are processed is likely central to both. The aim of the current study was to explore relationships between the domains of mood, emotional processing and coping and to analyse how anxiety affects coping, emotional processing, emotional balance and depression in people with MS. METHODS A cross-sectional questionnaire study involving 189 people with MS with a confirmed diagnosis of MS recruited from three French hospitals. Study participants completed a battery of questionnaires encompassing the following domains: i. anxiety and depression (Hospital Anxiety and Depression Scale (HADS)); ii. emotional processing (Emotional Processing Scale (EPS-25)); iii. positive and negative emotions (Positive and Negative Emotionality Scale (EPN-31)); iv. alexithymia (Bermond-Vorst Alexithymia Questionnaire) and v. coping (Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) questionnaire. Relationships between these domains were explored using path analysis. RESULTS Anxiety was a strong predictor of depression, in both a direct and indirect way, and our model explained 48% of the variance of depression. Gender and functional status (measured by the Expanded Disability Status Scale) played a modest role. Non-depressed people with MS reported high levels of negative emotions and low levels of positive emotions. Anxiety also had an indirect impact on depression via one of the subscales of the Emotional Processing Scale ("Unregulated Emotion") and via negative emotions (EPN-31). CONCLUSIONS This research confirms that anxiety is a vulnerability factor for depression via both direct and indirect pathways. Anxiety symptoms should therefore be assessed systematically and treated in order to lessen the likelihood of depression symptoms.
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Affiliation(s)
- Marie-Claire Gay
- Psychology Department, University of Paris West, Nanterre, France.
| | - Catherine Bungener
- Laboratory of Psychopathology, University of Paris Descartes, Paris, France.,Health Psychology, Université Paris Sorbonne Cité, Paris, France
| | - Sarah Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Pierre Vrignaud
- Psychology Department, University of Paris West, Nanterre, France
| | - Peter W Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Olivier Heinzlef
- Neurology Department, Hospital of Poissy-St-Germain en Laye, Paris, France
| | | | - Rana Assouad
- Neurology Department, GHPS Pitié Salpêtrière, Paris, France
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Csillik A, Bruce J, Catley D, Gay MC, Goggin KJ, Swaggart KR, Thomas PW, Thomas S. Psychological interventions for enhancing adherence to disease-modifying therapies (DMTs) in multiple sclerosis. Hippokratia 2016. [DOI: 10.1002/14651858.cd012443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Antonia Csillik
- University of Paris Ouest Nanterre; Department of Psychology; 200, Avenue de la République Nanterre La Dèfense Cedex France F-92001
| | - Jared Bruce
- University of Missouri-Kansas City; Department of Psychology; 5030 Cherry Street, Room 313 Kansas City Missouri USA 64110
| | - Delwyn Catley
- Children's Mercy Hospital & University of Missouri-Kansas City; 2401 Giham Road Kansas City MO USA 64108
| | - Marie-Claire Gay
- University of Paris Ouest Nanterre; Department of Psychology; 200, Avenue de la République Nanterre La Dèfense Cedex France F-92001
| | - Kathleen J Goggin
- Children's Mercy Hospital & University of Missouri; Health Services and Outcomes Research & Schools of Medicine and Pharmacy; 2401 Giham Road Kansas City MO USA 64108
| | - Keri R Swaggart
- The Children's Mercy Hospital and Clinics; Library Services; 2401 Gillham Road Kansas City MO USA 64108
| | - Peter W Thomas
- School of Health and Social Care, Bournemouth University; Bournemouth University, Clinical Research Unit, Faculty of Health and Social Sciences; R506A Royal London House Christchurch Road Bournemouth Dorset UK BH1 3LT
| | - Sarah Thomas
- School of Health and Social Care, Bournemouth University; Bournemouth University, Clinical Research Unit, Faculty of Health and Social Sciences; R506A Royal London House Christchurch Road Bournemouth Dorset UK BH1 3LT
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Abstract
In a healthcare environment that is trying to achieve better clinical outcomes and patient satisfaction, shared decision-making is a well-established concept that is gaining more interest. Multiple sclerosis is a preference-sensitive condition and provides the opportunity to implement decision aids at various decision points in the disease process. Literature about patient education and outcomes of shared decision aids in multiple sclerosis has been growing over the last decade. In this topical review, we present an overview of the current literature on shared decision-making in multiple sclerosis. While limitations to the generalizability and applicability of decision aids exist, there is evidence that decision aids and shared decision-making can be valuable tools in the clinical care of multiple sclerosis patients.
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Affiliation(s)
- Erica Colligan
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Abby Metzler
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Ezgi Tiryaki
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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28
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Saposnik G, Sempere AP, Raptis R, Prefasi D, Selchen D, Maurino J. Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS). BMC Neurol 2016; 16:58. [PMID: 27146451 PMCID: PMC4855476 DOI: 10.1186/s12883-016-0577-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/21/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. METHODS/DESIGN This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. CONCLUSIONS The present study applies an innovative approach by combining tools to assess medical decisions with experiments from Neuroeconomics that applies to common scenarios in MS care. Our results will help advance the field by providing a better understanding on the influence of cognitive factors (e.g., overconfidence, aversion to risk and uncertainty, herding) on medical decisions and therapeutic inertia in the management of MS which could lead to better outcomes.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, ON, M5C 1R6, Canada.
- Neuroeconomics and Decision Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland.
| | - Angel Perez Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Roula Raptis
- Applied Health Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Daniel Prefasi
- Neuroscience Area, Medical Department, Roche Farma, Madrid, Spain
| | - Daniel Selchen
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, ON, M5C 1R6, Canada
| | - Jorge Maurino
- Neuroscience Area, Medical Department, Roche Farma, Madrid, Spain
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29
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Vernooij RWM, Willson M, Gagliardi AR. Characterizing patient-oriented tools that could be packaged with guidelines to promote self-management and guideline adoption: a meta-review. Implement Sci 2016; 11:52. [PMID: 27079375 PMCID: PMC4832541 DOI: 10.1186/s13012-016-0419-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/02/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Self-management is an important component of care for patients or consumers (henceforth termed patients) with chronic conditions. Research shows that patients view guidelines as potential sources of self-management support. However, few guidelines provide such support. The primary purpose of this study was to characterize effective types of self-management interventions that could be packaged as resources in (i.e., appendices) or with guidelines (i.e., accompanying products). METHODS We conducted a meta-review of systematic reviews that evaluated self-management interventions. MEDLINE, EMBASE, and the Cochrane Library were searched from 2005 to 2014 for English language systematic reviews. Data were extracted on study characteristics, intervention (content, delivery, duration, personnel, single or multifaceted), and outcomes. Interventions were characterized by the type of component for different domains (inform, activate, collaborate). Summary statistics were used to report the characteristics, frequency, and impact of the types of self-management components. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the methodological quality of included reviews. RESULTS Seventy-seven studies were included (14 low, 44 moderate, 18 high risk of bias). Reviews addressed numerous clinical topics, most frequently diabetes (23, 30 %). Fifty-four focused on single (38 educational, 16 self-directed) and 21 on multifaceted interventions. Support for collaboration with providers was the least frequently used form of self-management. Most conditions featured multiple types of self-management components. The most frequently occurring type of self-management component across all studies was lifestyle advice (72 %), followed by psychological strategies (69 %), and information about the condition (49 %). In most reviews, the intervention both informed and activated patients (57, 76 %). Among the reviews that achieved positive results, 83 % of interventions involved activation alone, 94 % in combination with information, and 95 % in combination with information and collaboration. No trends in the characteristics and impact of self-management by condition were observed. CONCLUSIONS This study revealed numerous opportunities for enhancing guidelines with resources for both patients and providers to support self-management. This includes single resources that provide information and/or prompt activation. Further research is needed to more firmly establish the statistical association between the characteristics of self-management support and outcomes; and to and optimize the design of self-management resources that are included in or with guidelines, in particular, resources that prompt collaboration with providers.
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Affiliation(s)
- Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Melina Willson
- Systematic Reviews and Health Technology Assessments, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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30
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Colombo C, Filippini G, Synnot A, Hill S, Guglielmino R, Traversa S, Confalonieri P, Mosconi P, Tramacere I. Development and assessment of a website presenting evidence-based information for people with multiple sclerosis: the IN-DEEP project. BMC Neurol 2016; 16:30. [PMID: 26934873 PMCID: PMC4776365 DOI: 10.1186/s12883-016-0552-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 02/26/2016] [Indexed: 11/17/2022] Open
Abstract
Background People with multiple sclerosis (MS) are increasingly using the Internet in the daily management of their condition. They search for high-quality information in plain language, from independent sources, based on reliable and up-to-date evidence. The Integrating and Deriving Evidence, Experiences and Preferences (IN-DEEP) project in Italy and Australia aimed to provide people with MS and family members with an online source of evidence-based information, starting from their information needs. This paper reports on the Italian project’s website. Methods Contents, layout and wording were developed with people with MS and pilot-tested. The website was evaluated using an online 29-item questionnaire for ease of language, contents, navigation, and usefulness of information aimed at people with MS, family members and the general population. Results The website (http://indeep.istituto-besta.it/) is structured in multiple levels of information. The first topic was interferons-β for people with relapsing-remitting MS. In all, 433 people responded to the survey (276 people with MS, 68 family members and 89 others). The mean age was 45 years, almost 90 % had a high school diploma, about 80 % had relapsing-remitting MS, and the median disease duration was seven years. About 90 % judged the website clear, understandable, useful, and easy to navigate. Ninety percent of people with MS and family members would recommend it to others. Sixty-two percent reported they felt confident in making decisions on interferons-β after reading the website. Conclusions The model was judged clear and useful. It could be adapted to other topics and diseases. Clinicians may find it useful in their relationship with patients. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0552-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cinzia Colombo
- Department of Public Health, Laboratory for medical research and consumer involvement, IRCCS Mario Negri Institute for Pharmacological Research, via la Masa 19, 20156, Milan, Italy.
| | - Graziella Filippini
- Scientific Direction, Neurological Institute C. Besta IRCCS Foundation, via G. Celoria 11, 20133, Milan, Italy. .,Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group, Neurological Institute C. Besta IRCCS Foundation, via G. Celoria 11, 20133, Milan, Italy.
| | - Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, Victoria, 3086, Australia. .,National Trauma Research Institute, Monash University/The Alfred, Level 4, 89 Commercial Road Melbourne, Melbourne, 3004, Victoria, Australia.
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, Victoria, 3086, Australia.
| | - Roberta Guglielmino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.
| | - Silvia Traversa
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.
| | - Paolo Confalonieri
- Department of Neuroimmunology, Neurological Institute C. Besta IRCCS Foundation, Via G. Celoria 11, 20133, Milan, Italy.
| | - Paola Mosconi
- Department of Public Health, Laboratory for medical research and consumer involvement, IRCCS Mario Negri Institute for Pharmacological Research, via la Masa 19, 20156, Milan, Italy.
| | - Irene Tramacere
- Unit of Neuroepidemiology, Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group, Neurological Institute C. Besta IRCCS Foundation, Via G. Celoria 11, 20133, Milan, Italy.
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31
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Rahn AC, Köpke S, Kasper J, Vettorazzi E, Mühlhauser I, Heesen C. Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: study protocol for a cluster randomised controlled trial. Trials 2015; 16:106. [PMID: 25872529 PMCID: PMC4397890 DOI: 10.1186/s13063-015-0611-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis is a chronic neurological condition usually starting in early adulthood and regularly leading to severe disability. Immunotherapy options are growing in number and complexity, while costs of treatments are high and adherence rates remain low. Therefore, treatment decision-making has become more complex for patients. Structured decision coaching, based on the principles of evidence-based patient information and shared decision-making, has the potential to facilitate participation of individuals in the decision-making process. This cluster randomised controlled trial follows the assumption that decision coaching by trained nurses, using evidence-based patient information and preference elicitation, will facilitate informed choices and induce higher decision quality, as well as better decisional adherence. Methods/Design The decision coaching programme will be evaluated through an evaluator-blinded superiority cluster randomised controlled trial, including 300 patients with suspected or definite relapsing-remitting multiple sclerosis, facing an immunotherapy decision. The clusters are 12 multiple sclerosis outpatient clinics in Germany. Further, the trial will be accompanied by a mixed-methods process evaluation and a cost-effectiveness study. Nurses in the intervention group will be trained in shared decision-making, coaching, and evidence-based patient information principles. Patients who meet the inclusion criteria will receive decision coaching (intervention group) with up to three face-to-face coaching sessions with a trained nurse (decision coach) or counselling as usual (control group). Patients in both groups will be given access to an evidence-based online information tool. The primary outcome is ‘informed choice’ after six months, assessed with the multi-dimensional measure of informed choice including the sub-dimensions risk knowledge (questionnaire), attitude concerning immunotherapy (questionnaire), and immunotherapy uptake (telephone survey). Secondary outcomes include decisional conflict, adherence to immunotherapy decisions, autonomy preference, planned behaviour, coping self-efficacy, and perceived involvement in coaching and decisional encounters. Safety outcomes are comprised of anxiety and depression and disease-specific quality of life. Discussion This trial will assess the effectiveness of a new model of patient decision support concerning MS-immunotherapy options. The delegation of treatment information provision from physicians to trained nurses bears the potential to change current doctor-focused practice in Germany. Trial registration Current Controlled Trials (identifier: ISRCTN37929939), May 27, 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0611-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Christin Rahn
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany. .,Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.
| | - Jürgen Kasper
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, MH Building, N-9037, Tromsø, Norway.
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Ingrid Mühlhauser
- Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Christoph Heesen
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany. .,MS Day Hospital and Outpatient Unit, Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
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Colombo C, Mosconi P, Confalonieri P, Baroni I, Traversa S, Hill SJ, Synnot AJ, Oprandi N, Filippini G. Web search behavior and information needs of people with multiple sclerosis: focus group study and analysis of online postings. Interact J Med Res 2014; 3:e12. [PMID: 25093374 PMCID: PMC4150054 DOI: 10.2196/ijmr.3034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/28/2014] [Accepted: 05/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients and their family members increasingly seek health information on the Internet. There has been little exploration of how MS patients integrate health information with their needs, preferences, and values for decision making. The INtegrating and Deriving Evidence, Experiences, and Preferences (IN-DEEP) project is a collaboration between Italian and Australian researchers and MS patients, aimed to make high-quality evidence accessible and meaningful to MS patients and families, developing a Web-based resource of evidence-based information starting from their information needs. OBJECTIVE The objective of this study was to analyze MS patients and their family members' experience about the Web-based health information, to evaluate how they asses this information, and how they integrate health information with personal values. METHODS We organized 6 focus groups, 3 with MS patients and 3 with family members, in the Northern, Central, and Southern parts of Italy (April-June 2011). They included 40 MS patients aged between 18 and 60, diagnosed as having MS at least 3 months earlier, and 20 family members aged 18 and over, being relatives of a person with at least a 3-months MS diagnosis. The focus groups were audio-recorded and transcribed verbatim (Atlas software, V 6.0). Data were analyzed from a conceptual point of view through a coding system. An online forum was hosted by the Italian MS society on its Web platform to widen the collection of information. Nine questions were posted covering searching behavior, use of Web-based information, truthfulness of Web information. At the end, posts were downloaded and transcribed. RESULTS Information needs covered a comprehensive communication of diagnosis, prognosis, and adverse events of treatments, MS causes or risk factors, new drugs, practical, and lifestyle-related information. The Internet is considered useful by MS patients, however, at the beginning or in a later stage of the disease a refusal to actively search for information could occur. Participants used to search on the Web before or after their neurologist's visit or when a new therapy was proposed. Social networks are widely used to read others' stories and retrieve information about daily management. A critical issue was the difficulty of recognizing reliable information on the Web. Many sources were used but the neurologist was mostly the final source of treatment decisions. CONCLUSIONS MS patients used the Internet as a tool to integrate information about the illness. Information needs covered a wide spectrum, the searched topics changed with progression of the disease. Criteria for evaluating Internet accuracy and credibility of information were often lacking or generic. This may limit the empowerment of patients in health care choices.
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Affiliation(s)
- Cinzia Colombo
- IRCCS-Mario Negri Institute for Pharmacological Research, Milano, Italy, Department of Public Health, Laboratory for medical research and consumer involvement, Milano, Italy
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