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Newsome SD, Binns C, Kaunzner UW, Morgan S, Halper J. No Evidence of Disease Activity (NEDA) as a Clinical Assessment Tool for Multiple Sclerosis: Clinician and Patient Perspectives [Narrative Review]. Neurol Ther 2023; 12:1909-1935. [PMID: 37819598 PMCID: PMC10630288 DOI: 10.1007/s40120-023-00549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
The emergence of high-efficacy therapies for multiple sclerosis (MS), which target inflammation more effectively than traditional disease-modifying therapies, has led to a shift in MS management towards achieving the outcome assessment known as no evidence of disease activity (NEDA). The most common NEDA definition, termed NEDA-3, is a composite of three related measures of disease activity: no clinical relapses, no disability progression, and no radiological activity. NEDA has been frequently used as a composite endpoint in clinical trials, but there is growing interest in its use as an assessment tool to help patients and healthcare professionals navigate treatment decisions in the clinic. Raising awareness about NEDA may therefore help patients and clinicians make more informed decisions around MS management and improve overall MS care. This review aims to explore the potential utility of NEDA as a clinical decision-making tool and treatment target by summarizing the literature on its current use in the context of the expanding treatment landscape. We identify current challenges to the use of NEDA in clinical practice and detail the proposed amendments, such as the inclusion of alternative outcomes and biomarkers, to broaden the clinical information captured by NEDA. These themes are further illustrated with the real-life perspectives and experiences of our two patient authors with MS. This review is intended to be an educational resource to support discussions between clinicians and patients on this evolving approach to MS-specialized care.
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Affiliation(s)
- Scott D Newsome
- Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD, 21287, USA.
| | - Cherie Binns
- Multiple Sclerosis Foundation, 6520 N Andrews Avenue, Fort Lauderdale, FL, 33309, USA
| | | | - Seth Morgan
- National Multiple Sclerosis Society, 1 M Street SE, Suite 510, Washington, DC, 20003, USA
| | - June Halper
- Consortium of Multiple Sclerosis Centers, 3 University Plaza Drive Suite A, Hackensack, NJ, 07601, USA
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2
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Robles-Sanchez MA, Moharra M, Bosch-Farré C, Hernández-Leal MJ, Montalban X, Sastre-Garriga J, Ramió-Torrentà L, Bertran-Noguer C. Views of Multiple Sclerosis Patients About Key Elements for a Decision Aid: A Qualitative Study. J Neurosci Nurs 2023; 55:164-170. [PMID: 37527935 DOI: 10.1097/jnn.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT BACKGROUND: Patients with multiple sclerosis (MS) may experience decisional conflict during treatment choice. Shared decision making (SDM), whereby patients and health professionals, primarily nurses, collaborate in making decisions, reduces this decisional conflict. It requires understanding large amounts of information and may be complex, especially when decisions affect patients' autonomy and quality and prolongation of life. Patient decision aids are tools in facilitating SDM. This study aimed to identify the key elements from the perspective of patients with relapsing-remitting MS to create a patient decision aid in the Spanish sociocultural context. METHODS: This is a qualitative study using focus groups led by a clinical nurse specialist. Semistructured interviews included healthcare needs and demands, the SDM process, and general characteristics of a peer support program. After the transcription of interview recordings, data were analyzed by thematic analysis and a constructivist naturalistic approach. RESULTS: Patients with MS (27) from Spain participated in 4 focus groups of 90 to 120 minutes each. Three overarching themes were identified: information access to sufficient high-quality data; knowledge of available treatment options, including efficacy, adverse effects, frequency, administration route, and the impact on daily life; decision-making role, engaged versus nonengaged patients. The former require support in facilitating their active involvement in decisions, whereas the latter prefer more passive health models. CONCLUSION: The needs identified by patients with relapsing-remitting MS regarding treatment choice in the Spanish setting align with those reported by other studies. The identified themes provide valuable information to design and develop a virtual patient decision aid jointly by clinical MS nurses and patients according to the International Patient Decision Aid Standards Collaboration criteria. This aid will help improve understanding between nurses and patients during SDM and facilitate the process.
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3
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Thompson CM, Pulido MD, Babu S, Zenzola N, Chiu C. Communication between persons with multiple sclerosis and their health care providers: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3341-3368. [PMID: 35927111 DOI: 10.1016/j.pec.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study undertakes a scoping review of research about communication between persons with MS and their health care providers. DESIGN PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information. RESULTS Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making. CONCLUSION This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes. PRACTICE IMPLICATIONS Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA.
| | - Manuel D Pulido
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Sara Babu
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Nicole Zenzola
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Urbana, USA
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4
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Ubbink DT, Damman OC, de Jong BA. Shared decision-making in patients with multiple sclerosis. Front Neurol 2022; 13:1063904. [PMID: 36438979 PMCID: PMC9691958 DOI: 10.3389/fneur.2022.1063904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 09/09/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurological disorder impacting physical, cognitive, and psychosocial health. The disease course, severity, and presence of symptoms differ within and between persons over time and are unpredictable. Given the preference-sensitive nature of many key decisions to be made, and the increasing numbers of disease-modifying therapies, shared decision-making (SDM) with patients seems to be key in offering optimum care and outcomes for people suffering from MS. In this paper, we describe our perspective on how to achieve SDM in patients with MS, following key SDM-elements from established SDM-frameworks. As for deliberation in the clinical encounter, SDM communication training of professionals and feedback on their current performance are key aspects, as well as encouraging patients to participate. Concerning information for patients, it is important to provide balanced, evidence-based information about the benefits and the harms of different treatment options, including the option of surveillance only. At the same time, attention is needed for the optimal dosage of that information, given the symptoms of cognitive dysfunction and fatigue among MS-patients, and the uncertainties they have to cope with. Finally, for broader communication, a system is required that assures patient preferences are actually implemented by multidisciplinary MS-teams. As SDM is also being implemented in many countries within the context of value-based health care, we consider the systematic use of outcome information, such as patient-reported outcome measures (PROMs) and Patient Decision Aids, as an opportunity to achieve SDM.
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Affiliation(s)
- Dirk T. Ubbink
- Department of Surgery, Amsterdam University Medical Centers, Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Olga C. Damman
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Public Health Research Institute, Free University of Amsterdam, Amsterdam, Netherlands
| | - Brigit A. de Jong
- Department of Neurology, Amsterdam University Medical Centers, MS Center Amsterdam, Amsterdam Neuroscience Research Institute, Public Health Research Institute, Free University of Amsterdam, Amsterdam, Netherlands
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"I'm walking into the unknown": Qualitative insights into how emotions and lived experience related to multiple sclerosis diagnosis impact on decisions to pursue disease modifying treatment. Mult Scler Relat Disord 2021; 58:103464. [PMID: 34952250 DOI: 10.1016/j.msard.2021.103464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION People with Relapsing Remitting Multiple Sclerosis (RRMS) are increasingly included as active participants in shared decision making around their treatment options. Choosing a first disease modifying treatment (DMT) is a complex process that often takes place soon after a diagnosis has been given. Patients therefore are often required to make difficult decisions at a time when they are still coming to terms with their illness. This study investigated the views and experiences of recently diagnosed patients with RRMS when they were making their initial DMT choice. METHOD This was a qualitative study involving in-depth semi-structured interviews with patients with RRMS in a National Health Service (NHS) setting in the United Kingdom. Data were collected from 6 patients and analysis was guided by an Interpretive Phenomenological Analysis (IPA) approach. RESULTS Initial reactions to diagnosis were characterized by strong emotions and a feeling of despair and hopelessness. Subsequently the DMT decision was shaped by multiple considerations around maintaining normality, and restoring hope and control over one's life whilst reconciling uncertainty around efficacy. Considering the future with a DMT elicited reflections around employment and family planning. CONCLUSION Emotions and lived experience related to recent MS diagnosis can impact on the initial DMT decision in number of ways. Health care professionals need to understand the lived experience of patients making DMT decisions soon after diagnosis when engaging in shared decision making.
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Eilam-Stock T, Links J, Khan NZ, Bacon TE, Zuniga G, Laing L, Sammarco C, Sherman K, Charvet L. Adverse childhood experiences predict reaction to multiple sclerosis diagnosis. Health Psychol Open 2021; 8:20551029211052830. [PMID: 34707881 PMCID: PMC8543585 DOI: 10.1177/20551029211052830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective At the time of multiple sclerosis (MS) diagnosis, identifying those at risk for poorer health-related quality of life and emotional well-being can be a critical consideration for treatment planning. This study aimed to test whether adverse childhood experiences predict MS patients’ health-related quality of life and emotional functioning at time of diagnosis and initial course of disease. Methods We recruited patients at the time of new MS diagnosis to complete self-report surveys at baseline and a one-year follow-up. Questionnaires included the Adverse Childhood Experiences (ACEs), as well as the MS Knowledge Questionnaire (MSKQ), the 36-Item Short Form Health Survey (SF-36), and Self-Management Screening (SeMaS). Results A total of n = 31 participants recently diagnosed with relapsing remitting MS (median EDSS = 1.0, age M = 33.84 ± 8.4 years) completed the study measures. The ACEs significantly predicted health-related quality of life (SF-36) at baseline (Adjusted R2 = 0.18, p = 0.011) and follow-up (Adjusted R2 = 0.12, p = 0.03), baseline scores on the SeMaS Depression scale (Adjusted R2 = 0.19, p = 0.008), as well as follow-up scores on the SeMaS Anxiety (Adjusted R2 = 0.19, p = 0.014) and SeMaS Depression (Adjusted R2 = 0.14, p = 0.036) scales. Importantly, increased ACEs scores were predictive of increased anxiety at the one-year follow-up assessment, compared to baseline. Conclusions Childhood adversity predicts health-related quality of life and emotional well-being at time of MS diagnosis and over the initial course of the disease. Measured using a brief screening inventory (ACEs), routine administration may be useful for identifying patients in need of increased supportive services.
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Affiliation(s)
| | - Jon Links
- NYU Grossman School of Medicine, New York, NY, USA
| | - Nabil Z Khan
- SUNY Downstate School of Medicine, New York, NY, USA
| | | | | | - Lisa Laing
- NYU Grossman School of Medicine, New York, NY, USA
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7
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Haker M, Heesen C, Wenzel L, Köpke S, Rahn AC, Kasper J. Decision-making about corticosteroids in relapses of multiple sclerosis - development of a questionnaire based on the theory of planned behaviour. Mult Scler Relat Disord 2021; 55:103182. [PMID: 34358850 DOI: 10.1016/j.msard.2021.103182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relapses of multiple sclerosis are burdensome events and entail potentially lasting loss of function. People with multiple sclerosis have to consider corticosteroids, providing limited benefits and the risk of adverse effects. OBJECTIVE To develop and validate a questionnaire investigating the internal process of people with multiple sclerosis making decisions about corticosteroids. METHODS The questionnaire is structured by three domains, attitude, subjective social norm, and perceived behavioural control, which according to the theory of planned behaviour determine action planning. The development is inspired by a previous questionnaire studying decisions on immunotherapy. The questionnaire was tested in qualitative think-aloud interviews (n=10) for feasibility and comprehensibility and in an online survey (n=203) to assess construct and criterion validity. RESULTS The 18-item questionnaire was considered feasible and comprehensible. It predicted the intention to receive corticosteroids in up to 82.3% of cases. "Subjective social norm" impacted most on intention. The questionnaire also proved sensitive for autonomy preferences of people with multiple sclerosis. CONCLUSION This study shows that the questionnaire appropriately explains the internal process people with multiple sclerosis run through when considering corticosteroids. It can be used to inform developments of tailored support for people with multiple sclerosis in making informed decisions about relapse management.
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Affiliation(s)
- M Haker
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - C Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Wenzel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - J Kasper
- Institute of Nursing Sciences and Health Promotion, Faculty of Health Sciences, OsloMet, Metropolitan university, Oslo, Norway
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8
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Manzano A, Eskytė I, Ford HL, Bekker HL, Potrata B, Chataway J, Schmierer K, Pepper G, Meads D, Webb EJ, Pavitt SH. Impact of communication on first treatment decisions in people with relapsing-remitting multiple sclerosis. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30280-9. [PMID: 32456983 DOI: 10.1016/j.pec.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Disease-Modifying Treatments (DMTs) have contributed to a new clinical landscape for people with relapsing-remitting multiple sclerosis (pwRRMS). A challenge for services is how to support DMT decisions with changing clinical evidence, and differing treatment goals. This article investigates how pwRRMS weigh up the pros and cons of DMTs by examining how communication at the point of diagnosis is related to DMT decisions. METHODS 30 semi-structured interviews with pwRRMS in England were conducted using a theoretical purposive sampling strategy and analysed using the thematic approach to answer: How does communication about RRMS during diagnosis influence decisions about when and which DMT to choose? RESULTS Three meta-themes were identified: a) communication context; b) delayed communication and hope for people with "non-active" RRMS at diagnosis; c) people with "active" RRMS at diagnosis: Conflated, generic, selective and simplified information CONCLUSION: At the time of diagnosis, patient-physician interactions are characterised by emotions and information complexity. Clinical, social and psychological DMT filtering mechanisms are activated during first decisions. Personalised evidence is needed to make informed decisions. PRACTICE IMPLICATIONS Patient decision aids should consider first and consecutive decisions and should not encourage a false sense of large choices that could add to decision anxiety.
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Affiliation(s)
- Ana Manzano
- School of Sociology & Social Policy, Room 11.20 Social Sciences Building, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, United Kingdom
| | - Helen L Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jeremy Chataway
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Klaus Schmierer
- Blizard Institute (Neuroscience), Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Edward Jd Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
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9
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van Eijndhoven E, Brauer M, Kee R, MacEwan J, Mucha L, Wong SL, Durand A, Shafrin J. Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis. J Med Econ 2020; 23:474-483. [PMID: 31903813 DOI: 10.1080/13696998.2019.1711100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: Model how moving from current disease-modifying drug (DMD) prescribing patterns for relapsing-remitting multiple sclerosis (RRMS) observed in the United Kingdom (UK) to prescribing patterns based on patient preferences would impact health outcomes over time.Materials and methods: A cohort-based Markov model was used to measure the effect of DMDs on long-term health outcomes for individuals with RRMS. Data from a discrete choice experiment were used to estimate the market shares of DMDs based on patient preferences (i.e. preference shares). These preference shares and real-world UK market shares were used to calculate the effect of prescribing behavior on relapses, disability progression, and quality-adjusted life-years (QALYs). The incremental benefit of patient-centered prescribing over current practices for the UK RRMS population was then estimated; scenario and sensitivity analyses were also conducted.Results: Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (-6.8% and +4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions.Limitations: Treatment efficacy estimates applied to various models in this study were based on data derived from clinical trials, rather than real-world data; the impact of patient-centered prescribing on treatment adherence and/or switching was not modeled.Conclusions: The population of UK RRMS patients may experience overall health gains if patient preferences are better incorporated into prescribing practices.
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Affiliation(s)
| | | | - Rebecca Kee
- Precision Health Economics, Los Angeles, CA, USA
| | | | - Lisa Mucha
- Global Evidence & Value Development, Global Research & Development, EMD Serono Inc, Billerica, MA, USA
| | - Schiffon L Wong
- Global Evidence & Value Development, Global Research & Development, EMD Serono Inc, Billerica, MA, USA
| | - Adeline Durand
- Global Evidence & Value Development, Global Research & Development, EMD Serono Inc, Billerica, MA, USA
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10
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Tortorella C, Solaro C, Annovazzi P, Boffa L, Buscarinu MC, Buttari F, Calabrese M, Cavalla P, Cocco E, Cordioli C, De Luca G, Di Filippo M, Fantozzi R, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Fermo SL, Malucchi S, Maniscalco GT, Moccia M, Nociti V, Paolicelli D, Pesci I, Prosperini L, Ragonese P, Tomassini V, Clerici VLAT, Rodegher M, Gherardi M, Gasperini C. Informing MS patients on treatment options: a consensus on the process of consent taking. Neurol Sci 2020; 41:2249-2253. [PMID: 32240416 DOI: 10.1007/s10072-020-04339-z] [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: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. AIMS: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. RESULTS: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS.
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Affiliation(s)
- C Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
| | - C Solaro
- Department of Rehabilitation, Mons L Novarese Hospital, Moncrivello, Italy
| | - P Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, PO di Gallarate, (VA), Italy
| | - L Boffa
- Department of Neurosciences, MS Center, Tor Vergata University, Rome, Italy
| | - M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs Sapienza University Rome, Rome, Italy
| | - F Buttari
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - M Calabrese
- Neurology B, Department of Neurosciences Biomedicine and Movements, University of Verona, Verona, Italy
| | - P Cavalla
- MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy
| | - E Cocco
- Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cordioli
- Multiple Sclerosis Center, ospedale di Montichiari, Spedali Civili di Brescia, Montichiari, Italy
| | - G De Luca
- Neurology Clinic, Multiple Sclerosis Center SS. Annunziata Hospital, Chieti, Italy
| | - M Di Filippo
- Clinica Neurologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - R Fantozzi
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - D Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Science, University of Campania, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Laroni
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Lo Fermo
- Clinica Neurologica A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - S Malucchi
- Neurologia 2-CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - G T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - V Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario 'A Gemelli' IRCCS, Rome, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - I Pesci
- Ospedale di Vaio, Centro SM, Fidenza, Parma, Italy
| | - L Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - P Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Palermo, Italy
| | - V Tomassini
- Department of Neurosciences, Imaging and Clinical Sciences, School of Medicine, Institute for Advanced Biomedical Technologies (ITAB), University of Chieti-Pescara "G. d'Annunzio, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - V L A Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - M Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Gherardi
- SC Medicina Legale AUSL Valle D'Aosta, Aosta, Italy
| | - C Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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11
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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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Bansback N, Chiu JA, Carruthers R, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Lynd LD, Traboulsee A. Development and usability testing of a patient decision aid for newly diagnosed relapsing multiple sclerosis patients. BMC Neurol 2019; 19:173. [PMID: 31325961 PMCID: PMC6642472 DOI: 10.1186/s12883-019-1382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients often struggle with treatment decisions, in part due to the increasing number of approved disease modifying therapies, each with different characteristics, and also since physicians can struggle to identify which of these characteristics matter most to each individual patient. Decision uncertainty can contribute to late treatment initiation and treatment non-adherence-causes of 'undertreatment' in MS. An interactive online patient decision aid that informs patients of their options, considers their individual preferences and goals, and facilitates conversations with their physicians, could improve how patients with relapsing forms of MS make evidence-based treatment decisions. OBJECTIVE To develop and evaluate a prototype patient decision aid (PtDA) for first-line disease modifying therapies for relapsing-remitting multiple sclerosis. METHODS Informed by previous studies and International Patient Decision Aid Standards guidelines, a prototype PtDA was developed for patients with relapsing multiple sclerosis considering first line treatment. Patients with relapsing multiple sclerosis were recruited from the University of British Columbia's Multiple Sclerosis Clinic to participate in either an online survey or a focus group. Online survey participants completed the PtDA, followed by measures of acceptability, usability, and preparedness for decision-making, and provided general feedback. Focus group participants assessed usability of the revised PtDA. The analysis of qualitative and quantitative data led to improvements of the PtDA prototype. RESULTS The prototype PtDA received high ratings for acceptability and usability, and after its use, participants reported high-levels of preparedness for decision-making. Analysis of all qualitative data identified three key themes: the need for credible information; the usefulness of the PtDA; and the importance of normalizing and sharing experiences. Nine content areas were identified for revision. Overall, participants found the PtDA to be a valuable tool for facilitating treatment decisions. CONCLUSIONS This mixed methods study has led to the development of a PtDA that can support patients with RRMS as they make treatment decisions. Future studies will assess the feasibility of implementation and the impact of the PtDA on both the timely treatment initiation and longer-term adherence.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Judy A. Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Emmanuelle Lapointe
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Alice Schabas
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | | | - Larry D. Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
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Rumrill, PD, Bishop M. Multiple sclerosis: A high-incidence immune-mediated disease of the central nervous system. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rae-Grant AD. Incorporating Clinical Practice Guidelines and Quality Measures Into High-Quality Cost-Effective Care for Patients With Multiple Sclerosis. Continuum (Minneap Minn) 2019; 25:845-849. [DOI: 10.1212/con.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Barclay K, Carruthers R, Traboulsee A, Bass AD, LaGanke C, Bertolotto A, Boster A, Celius EG, de Seze J, Cruz DD, Habek M, Lee JM, Limmroth V, Meuth SG, Oreja-Guevara C, Pagnotta P, Vos C, Ziemssen T, Baker DP, Wijmeersch BV. Best Practices for Long-Term Monitoring and Follow-Up of Alemtuzumab-Treated MS Patients in Real-World Clinical Settings. Front Neurol 2019; 10:253. [PMID: 30967831 PMCID: PMC6439479 DOI: 10.3389/fneur.2019.00253] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/25/2019] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune neurological disease that typically affects young adults, causing irreversible physical disability and cognitive impairment. Alemtuzumab, administered intravenously as 2 initial courses of 12 mg/day (5 consecutive days at baseline, and 3 consecutive days 12 months later), resulted in significantly greater improvements in clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in patients with active relapsing-remitting MS (RRMS) who were either treatment-naive (CARE-MS I; NCT00530348) or had an inadequate response to prior therapy (CARE-MS II; NCT00548405). Efficacy with alemtuzumab was maintained over 7 years in subsequent extension studies (NCT00930553; NCT02255656), in the absence of continuous treatment and with a consistent safety profile. There is an increased incidence of autoimmune events in patients treated with alemtuzumab (mainly thyroid events, but also immune thrombocytopenia and nephropathy), which imparts a need for mandatory safety monitoring for 4 years following the last treatment. The risk management strategy for alemtuzumab-treated patients includes laboratory monitoring and a comprehensive patient education and support program that enables early detection and effective management of autoimmune events, yielding optimal outcomes for MS patients. Here we provide an overview of tools and techniques that have been implemented in real-world clinical settings to reduce the burden of monitoring for both patients and healthcare providers, including customized educational materials, the use of social media, and interactive online databases for managing healthcare data. Many practices are also enhancing patient outreach efforts through coordination with specialized nursing services and ancillary caregivers. The best practice recommendations for safety monitoring described in this article, based on experiences in real-world clinical settings, may enable early detection and management of autoimmune events, and help with implementation of monitoring requirements while maximizing the benefits of alemtuzumab treatment for MS patients.
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Affiliation(s)
| | | | | | - Ann D. Bass
- Neurology Center of San Antonio, San Antonio, TX, United States
| | | | | | - Aaron Boster
- OhioHealth Neurological Physicians, Columbus, OH, United States
| | - Elisabeth G. Celius
- Oslo University Hospital Ullevål and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jérôme de Seze
- Clinical Research Center (CIC), INSERM 1434, Strasbourg University, Strasbourg, France
| | | | - Mario Habek
- University of Zagreb, School of Medicine and University Medical Center, Zagreb, Croatia
| | - Jong-Mi Lee
- Stanford Healthcare, Palo Alto, CA, United States
| | - Volker Limmroth
- Klinik für Neurologie und Palliativmedizin, Cologne, Germany
| | - Sven G. Meuth
- Clinic of Neurology with Institute of Translational Neurology, University Hospital Müenster, Müenster, Germany
| | - Celia Oreja-Guevara
- El Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Cindy Vos
- Revalidatie & MS Centrum, Overpelt, Belgium
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus, Dresden, Germany
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Understanding treatment decisions from the perspective of people with relapsing remitting multiple Sclerosis: A critical interpretive synthesis. Mult Scler Relat Disord 2018; 27:370-377. [PMID: 30476873 DOI: 10.1016/j.msard.2018.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/31/2018] [Accepted: 11/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system that mainly affects young adults. While there is no cure for MS, disease modifying treatments (DMTs) reduce the relapse rate and partial accrual of disability. More effective DMTs may have higher risks including life-threatening infections or secondary autoimmunity. The complexity and novelty of available treatments cause challenges for clinicians when prescribing treatments and for people with MS (PwMS) when deciding what trade-offs they are willing and ready to make. OBJECTIVE To explore the experience of people with relapsing remitting MS (PwRRMS) and their perspectives in choosing treatments. METHODS Critical interpretive synthesis was employed to review and synthesis the published literature. Eighty-three publications were selected in a multi-step systematic process. RESULTS Findings are presented in four interrelated areas: the influence of the clinical evidence-base in decision making; the meaning of DMT efficacy for PwRRMS; the influence of models of decision-making and information acquisition practices in PwRRMS; and the importance of psychosocial dimensions in DMT decision making. Synthesis of the findings revealed that alongside medical and individual reasoning, contextual circumstances play an important role in making treatment decisions. CONCLUSION This review identifies and explains the importance of diverse contextual circumstances (clinical, social, psychological) that are important for PwRRMS when making treatment decisions. The findings demonstrate the importance of eliciting, understanding and addressing such contextual factors.
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17
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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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Efendi H, Boz C, Karabudak R. Evaluating Treatment Decision for Multiple Sclerosis: Real Life and Patient Experiences. ACTA ACUST UNITED AC 2018; 55:S10-S14. [PMID: 30692848 DOI: 10.29399/npa.23164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There are different decision-making models in medicine for treatment decisions. Shared decision-making model is the most appropriate and widely used model for chronic diseases like Multiple Sclerosis (MS). In this model, the decision making process like treatment options is being discussed step by step between patients and physicians. However, increasing treatment options and medication side effects make the decision-making process more difficult for physicians and reveal the need to share wider knowledge with the patient. In this article we evaluate treatment decision making in patients with MS involving real life experiences.
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Affiliation(s)
- Hüsnü Efendi
- Department of Neurology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Cavit Boz
- Department of Neurology, Technical University, School of Medicine, Trabzon, Turkey
| | - Rana Karabudak
- Department of Neurology, Hacettepe University, School of Medicine, Ankara, Turkey
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Kamali S, Ahmadian L, Khajouei R, Bahaadinbeigy K. Health information needs of pregnant women: information sources, motives and barriers. Health Info Libr J 2017; 35:24-37. [PMID: 29131537 DOI: 10.1111/hir.12200] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 09/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pregnant women should be provided with relevant and useful information to manage this specific period of their lives. Assessing information needs of this group is a prerequisite for providing this information. OBJECTIVE The aim of this study was to assess the information needs of pregnant women during their pregnancy and childbirth. METHODS This descriptive study was conducted on the pregnant women who attended antenatal clinics and obstetricians/gynaecologists' offices in Kerman, Iran, in 2015. Data were collected using a self-administered, valid and reliable questionnaire. A total of 400 women participated in the study. FINDINGS Most pregnant women needed information about care of the foetus (n = 344, 86%), physical and psychological complications after delivery (n = 333, 83%), development and growth of the foetus (n = 330, 82.5%), pregnancy nutrition (n = 327, 82%) and special tests during pregnancy (n = 326, 81.5%). They mostly (n = 195, 49%) looked for information when they were suffering from a disease or pregnancy complications. CONCLUSIONS As pregnant women need extensive information to be able to take care of themselves and their babies, their information needs should be identified and taken into consideration when planning educational programmes for this group of women.
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Affiliation(s)
- Sudabeh Kamali
- Health Information Sciences Department, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Driedger SM, Maier R, Marrie RA, Brouwers M. Caught in a no-win situation: discussions about CCSVI between persons with multiple sclerosis and their neurologists - a qualitative study. BMC Neurol 2017; 17:176. [PMID: 28882115 PMCID: PMC5590111 DOI: 10.1186/s12883-017-0954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/27/2017] [Indexed: 12/05/2022] Open
Abstract
Background In recent years, shared decision making (SDM) has been promoted as a model to guide interactions between persons with MS and their neurologists to reach mutually satisfying decisions about disease management – generally about deciding treatment courses of prevailing disease modifying therapies. In 2009, Dr. Paolo Zamboni introduced the world to his hypothesis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) as a cause of MS and proposed venous angioplasty (‘liberation therapy’) as a potential therapy. This study explores the discussions that took place between persons with MS (PwMS) and their neurologists about CCSVI against the backdrop of the recent calls for the use of SDM to guide clinical conversations. Methods In 2012, study researchers conducted focus groups with PwMS (n = 69) in Winnipeg, Canada. Interviews with key informants were also carried out with 15 participants across Canada who were stakeholders in the MS community: advocacy organizations, MS clinicians (i.e. neurologists, nurses), clinical researchers, and government health policy makers. Results PwMS reported a variety of experiences when attempting to discuss CCSVI with their neurologist. Some found that there was little effort to engage in desired discussions or were dissatisfied with critical or cautious stances of their neurologist. This led to communication breakdowns, broken relationships, and decisions to autonomously access alternative opinions or liberation therapy. Other participants were appreciative when clinicians engaged them in discussions and were more receptive to more critical appraisals of the evidence. Key informants reported that they too had heard of neurologists who refused to discuss CCSVI with patients and that neurology as a whole had been particularly vilified for their response to the hypothesis. Clinicians indicated that they had shared information as best they could but recommended against seeking liberation therapy. They noted that being respectful of patient emotions, values, and hope were also key to maintaining good relationships. Conclusions While CCSVI proved a challenging context to carry out patient-physician discussions and brought numerous tensions to the surface, following the approach of SDM can minimize the potential for unfortunate outcomes as much as possible because it is based on principles of respect and more two-way communication. Electronic supplementary material The online version of this article (10.1186/s12883-017-0954-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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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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Synnot AJ, Hill SJ, Garner KA, Summers MP, Filippini G, Osborne RH, Shapland SD, Colombo C, Mosconi P. Online health information seeking: how people with multiple sclerosis find, assess and integrate treatment information to manage their health. Health Expect 2016; 19:727-37. [PMID: 25165024 PMCID: PMC5055229 DOI: 10.1111/hex.12253] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Internet is increasingly prominent as a source of health information for people with multiple sclerosis (MS). But there has been little exploration of the needs, experiences and preferences of people with MS for integrating treatment information into decision making, in the context of searching on the Internet. This was the aim of our study. DESIGN Sixty participants (51 people with MS; nine family members) took part in a focus group or online forum. They were asked to describe how they find and assess reliable treatment information (particularly online) and how this changes over time. Thematic analysis was underpinned by a coding frame. RESULTS Participants described that there was both too much information online and too little that applied to them. They spoke of wariness and scepticism but also empowerment. The availability of up-to-date and unbiased treatment information, including practical and lifestyle-related information, was important to many. Many participants were keen to engage in a 'research partnership' with health professionals and developed a range of strategies to enhance the trustworthiness of online information. We use the term 'self-regulation' to capture the variations in information seeking behaviour that participants described over time, as they responded to their changing information needs, their emotional state and growing expertise about MS. CONCLUSIONS People with MS have developed a number of strategies to both find and integrate treatment information from a range of sources. Their reflections informed the development of an evidence-based consumer web site based on summaries of MS Cochrane reviews.
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Affiliation(s)
- Anneliese J. Synnot
- Centre for Health Communication and ParticipationDepartment of Public HealthSchool of Public Health and Human BiosciencesLa Trobe UniversityMelbourneVic.Australia
| | - Sophie J. Hill
- Centre for Health Communication and ParticipationDepartment of Public HealthSchool of Public Health and Human BiosciencesLa Trobe UniversityMelbourneVic.Australia
| | - Kerryn A. Garner
- Centre for Health Communication and ParticipationDepartment of Public HealthSchool of Public Health and Human BiosciencesLa Trobe UniversityMelbourneVic.Australia
| | - Michael P. Summers
- Centre for Health Communication and ParticipationDepartment of Public HealthSchool of Public Health and Human BiosciencesLa Trobe UniversityMelbourneVic.Australia
| | - Graziella Filippini
- Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review GroupUnit of NeuroepidemiologyFondazione IRCCS Istituto Neurologico, C. BestaMilanItaly
| | - Richard H. Osborne
- Public Health InnovationPopulation Health Strategic Research CentreSchool of Health and Social DevelopmentDeakin UniversityMelbourneVic.Australia
| | | | - Cinzia Colombo
- Laboratory for medical research and consumer involvementDepartment of Public HealthIRCSS‐Mario NegriInstitute for Pharmacological ResearchMilanItaly
| | - Paola Mosconi
- Laboratory for medical research and consumer involvementDepartment of Public HealthIRCSS‐Mario NegriInstitute for Pharmacological ResearchMilanItaly
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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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Fox RJ, Salter A, Alster JM, Dawson NV, Kattan MW, Miller D, Ramesh S, Tyry T, Wells BW, Cutter G. Risk tolerance to MS therapies: Survey results from the NARCOMS registry. Mult Scler Relat Disord 2015; 4:241-9. [PMID: 26008941 DOI: 10.1016/j.msard.2015.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is little information about risk acceptance of multiple sclerosis (MS) patients to various MS therapies. OBJECTIVE To determine MS patients׳ tolerance to risky therapies and identify associated characteristics. METHODS MS patients from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry׳s online cohort were invited to complete questionnaires on decision making and risk tolerance (RT) to two therapeutic scenarios: a theoretical cure for MS [CureMS], with permanent reversal of all MS symptoms but a risk of immediate painless death; and natalizumab [NAT], a real-life scenario with benefits and risks as defined by Phase III trial results. RESULTS The median RT for both scenarios was 1:10,000; 15-23% of respondents were not willing to take any risk for their MS therapy. Participants with greater disability or not taking any MS therapy showed a greater RT, while females and those caring for dependents had a lower RT. Females and older age were predictors of lower RT, while increasing disability and greater blunting attitude with respect to information seeking behavior were predictors of higher RT. CONCLUSION MS patients displayed a wide range of RT for MS therapies. Our study identified gender, age, disability and information seeking behavior to be associated with RT.
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Affiliation(s)
- Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Amber Salter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joan M Alster
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Neal V Dawson
- Center for Health Care and Research Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah Miller
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sneha Ramesh
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tuula Tyry
- Barrows Neurological Institute, Phoenix, AZ, USA
| | - Brian W Wells
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
Objective:To compare neurologist and patient perceptions of multiple sclerosis (MS)-related health status.Methods:MS patients (n=99) were recruited from six sites in Canada. Following a consultation with their neurologist, patients estimated their relapse frequency, rated their general health and quality of life (QoL), reviewed descriptions of eight health domains and selected the three most important, and completed a utility assessment using the standard gamble (SG). Concurrently, neurologists independently used the same instruments to rate their patients' health status. Assessments were compared on the basis of paired mean values of both groups and the degree of exact agreement quantified by intraclass coefficient (ICC) and kappa analyses, which yield values of 1.0 with 100% agreement.Results:There were significant differences (p<0.001) between patient and neurologist ratings for relapses in the last year (0.86 vs. 0.4, respectively), QoL (61.2 vs. 69.7 (maximum score = 100) and utility (0.864 vs. 0.971); ICC analysis revealed moderate to poor levels of agreement (0.56 for QoL to 0.03 for SG). There was little concordance in identification of important health domain and the only significant associations were in bodily pain and social functioning (kappa statistic = 0.24, p = 0.026 for both). Neurologists identified physical functioning domains as important, while patients placed more emphasis on mental health domains.Conclusions:Discrepancies between neurologist and patient perceptions of MS were observed. The study identifies a need to educate neurologists on the recognition of MS health domains that are important in the definition of patient QoL.
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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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Salter AR, Marrie RA, Agashivala N, Belletti DA, Kim E, Cutter GR, Cofield SS, Tyry T. Patient perspectives on switching disease-modifying therapies in the NARCOMS registry. Patient Prefer Adherence 2014; 8:971-9. [PMID: 25045254 PMCID: PMC4094626 DOI: 10.2147/ppa.s49903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The evolving landscape of disease-modifying therapies (DMTs) for multiple sclerosis raises important questions about why patients change DMTs. Physicians and patients could benefit from a better understanding of the reasons for switching therapy. PURPOSE To investigate the reasons patients switch DMTs and identify characteristics associated with the decision to switch. METHOD The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry conducted a supplemental survey among registry participants responding to the 2011 update survey. The supplemental survey investigated reasons for switching DMT, origin of the discussion of DMT change, and which factors influenced the decision. Chi-square tests, Fisher's exact tests, and logistic regression were used for the analyses. RESULTS Of the 691 eligible candidates, 308 responded and met the inclusion criteria (relapsing disease course, switched DMT after September 2010). The responders were 83.4% female, on average 52 years old, with a median (interquartile range) Patient-Determined Disease Steps score of 4 (2-5). The most recent prior therapy included first-line injectables (74.5%), infusions (18.1%), an oral DMT (3.4%), and other DMTs (4.0%). The discussion to switch DMT was initiated almost equally by physicians and participants. The primary reason for choosing the new DMT was based most frequently on physician's recommendation (24.5%) and patient perception of efficacy (13.7%). CONCLUSION Participants frequently initiated the discussion regarding changing DMT, although physician recommendations regarding the specific therapy were still weighed highly. Long-term follow-up of these participants will provide valuable information on their disease trajectory, satisfaction with, and effectiveness of their new medication.
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Affiliation(s)
- Amber R Salter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Edward Kim
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tuula Tyry
- Division of Neurology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Köpke S, Solari A, Khan F, Heesen C, Giordano A. Information provision for people with multiple sclerosis. Cochrane Database Syst Rev 2014:CD008757. [PMID: 24752330 DOI: 10.1002/14651858.cd008757.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. Among others, these include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies and non-pharmacological interventions. It has been shown that people with MS demand adequate information to be able to actively participate in medical decision making and to self-manage their disease. On the other hand, it has been found that patients' disease-related knowledge is poor. Therefore, guidelines have recommended 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 and, accordingly, a number of information and decision support programmes have been published. OBJECTIVES To evaluate the effectiveness of information provision interventions for people with MS that aim to promote informed choice and improve patient-relevant outcomes. SEARCH METHODS 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 2013, Issue 6), MEDLINE, EMBASE, CINAHL, LILACS, PEDro and clinical trials registries (12 June 2013) as well as other sources. In addition, we searched PsycINFO, trial registries, and reference lists of identified articles. We also contacted trialists. SELECTION CRITERIA Randomised controlled trials, 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 Ten randomised controlled trials involving a total of 1314 participants met the inclusion criteria and were analysed. 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 interventions contained decision aids, educational programmes, self-care interventions and personal interviews with physicians. All interventions were complex interventions using more than one active component, but the number and extent of the intervention components differed markedly between studies. The studies had a variable risk of bias. We did not perform meta-analyses due to marked clinical heterogeneity. All four studies assessing MS-related knowledge (524 participants; moderate-quality 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 from four studies reporting effects on decision making (836 participants; low-quality evidence) and from five studies assessing quality of life (605 participants; low-quality evidence). There were no adverse events in the six studies reporting on adverse events. 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. There seem to be no negative side effects from informing patients about their disease. Interpretation of study results remains challenging due to the marked heterogeneity of the interventions and outcome measures.
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Affiliation(s)
- Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany, D-23538
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Treatment of multiple sclerosis in Germany: an analysis based on claims data of more than 30,000 patients. Int J Clin Pharm 2013; 35:1229-35. [PMID: 24104761 DOI: 10.1007/s11096-013-9857-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an incurable disease of the central nervous system. In addition to symptomatic treatment, immunomodulatory and immunosuppressant agents are used to prevent attacks and to influence the course of disease. OBJECTIVE The goal of this study was to assess the drug use of MS patients in outpatient care considering gender-related and regional differences. SETTING We analyzed outpatient claims data of the single largest German health insurance fund (about 9 million insurants) for the year 2010. METHOD Patients with MS were identified by outpatient ICD-10-GM-diagnosis code 'G35'. All age groups were included. MS-specific drug use was analysed for those patients, considering regional and gender-related differences in specific drug prescriptions. MAIN OUTCOME MEASURE Prescription rates for symptomatic treatment, relapse treatment and disease-modifying treatment. RESULTS 31,248 patients with a diagnosis of MS were identified (0.35 % of all insurants). Their mean age was 50.4 ± 14.1 years, 77.7 % of them were female. 37.6 % of the included patients were treated with disease-modifying drugs, 23.4 % got prescriptions for corticosteroids, drugs of choice for relapse therapy, and 63.1 % received symptomatic treatment as defined in the study. Women with MS were prescribed significantly more non-steroidal anti-inflammatory drugs, urinary antispasmodics, antidepressants, tranquilizer and hypnotic drugs. Regional variations were also found, with highest usage of disease-modifying drugs in eastern regions of Germany. CONCLUSION This study gives an insight into the treatment of MS in daily practice by using the claims data of a large health insurance company. The prescription rate for disease modifying drugs was relatively low suggesting that early treatment was not routine practice. Furthermore, the results indicated that women with MS were more likely to receive treatment for psychiatric symptoms and pain.
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30
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Hill S, Filippini G, Synnot A, Summers M, Beecher D, Colombo C, Mosconi P, Battaglia MA, Shapland S, Osborne RH, Hawkins M. Presenting evidence-based health information for people with multiple sclerosis: the IN-DEEP project protocol. BMC Med Inform Decis Mak 2012; 12:20. [PMID: 22424304 PMCID: PMC3315402 DOI: 10.1186/1472-6947-12-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 03/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background Increasingly, evidence-based health information, in particular evidence from systematic reviews, is being made available to lay audiences, in addition to health professionals. Research efforts have focused on different formats for the lay presentation of health information. However, there is a paucity of data on how patients integrate evidence-based health information with other factors such as their preferences for information and experiences with information-seeking. The aim of this project is to explore how people with multiple sclerosis (MS) integrate health information with their needs, experiences, preferences and values and how these factors can be incorporated into an online resource of evidence-based health information provision for people with MS and their families. Methods This project is an Australian-Italian collaboration between researchers, MS societies and people with MS. Using a four-stage mixed methods design, a model will be developed for presenting evidence-based health information on the Internet for people with MS and their families. This evidence-based health information will draw upon systematic reviews of MS interventions from The Cochrane Library. Each stage of the project will build on the last. After conducting focus groups with people with MS and their family members (Stage 1), we will develop a model for summarising and presenting Cochrane MS reviews that is integrated with supporting information to aid understanding and decision making. This will be reviewed and finalised with people with MS, family members, health professionals and MS Society staff (Stage 2), before being uploaded to the Internet and evaluated (Stages 3 and 4). Discussion This project aims to produce accessible and meaningful evidence-based health information about MS for use in the varied decision making and management situations people encounter in everyday life. It is expected that the findings will be relevant to broader efforts to provide evidence-based health information for patients and the general public. The international collaboration also permits exploration of cultural differences that could inform international practice.
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Affiliation(s)
- Sophie Hill
- Centre for Health Communication and Participation, Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia.
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Kachuck NJ. When neurologist and patient disagree on reasonable risk: new challenges in prescribing for patients with multiple sclerosis. Neuropsychiatr Dis Treat 2011; 7:197-208. [PMID: 21573081 PMCID: PMC3090283 DOI: 10.2147/ndt.s17522] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Indexed: 01/28/2023] Open
Abstract
New more powerful therapies for the treatment of multiple sclerosis may also confer a potential for unprecedented life-endangering side effects. How does a physician respond to a patient's request for a treatment the benefit of which cannot be clearly established as worth its risk? The current challenge with prescription of natalizumab (Tysabri(®), Biogen Idec) is used to illustrate how this conflict creates an opportunity to re-examine our goals as physicians and the nature of the physician-patient relationship. Understanding the physician's role in that partnership, and the ethical and psychological issues impacting on how reasonable risk is determined, can improve the neurologist's capacity to explicate such quandaries. Redefining what is required to mediate disagreement between doctors and patients about reasonable risk is at the heart of why many of us became physicians. However, such nuanced interpersonal dynamics of patient care can be neglected due to the time and resource pressures of our practices. These demands have increased the seductiveness of the efficiencies promoted by the trend toward the pseudo-objectification of evidence-based care, which has arguably monopolized the healing conversation often to the detriment of the shared narrative. We examine and attempt to reframe the fiduciary and biopsychosocial contretemps of the doctor and patient disagreeing on risk, emphasizing its humanistic, relational dimensions.
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Affiliation(s)
- Norman J Kachuck
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Heesen C, Kleiter I, Nguyen F, Schäffler N, Kasper J, Köpke S, Gaissmaier W. Risk perception in natalizumab-treated multiple sclerosis patients and their neurologists. Mult Scler 2010; 16:1507-12. [PMID: 20826527 DOI: 10.1177/1352458510379819] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Natalizumab is associated with the potentially life-threatening side-effect progressive multifocal leukoencephalopathy (PML). Little is known about patients' and physicians' risk estimates and attitudes towards natalizumab treatment. METHODS Consecutive natalizumab-treated patients (n = 69) and neurologists (n = 66) in two centres and cooperating private practices received an evidence-based three-page information leaflet about natalizumab-associated PML and an evaluation sheet. RESULTS After reading the information, patients were significantly more likely than physicians to intend continuation of natalizumab treatment and willing to accept higher risks of PML: 49% of physicians would stop treatment at a PML risk of 2:10,000 or lower, while only 17% of patients would do so (p < 0.001). This difference could not be explained by risk calculation abilities or lack of understanding. Both groups overestimated natalizumab treatment effects. CONCLUSION Patients had a significantly worse perception of multiple sclerosis as a malignant disease. We conclude that patients were willing to accept a higher risk of PML than neurologists. Coherent with their perception of risks and benefits, patients were also more willing to continue treatment. Open information about treatment-related risks is appreciated and might support shared decision making.
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Affiliation(s)
- Christoph Heesen
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Zhang Y, Su H, Shang L, Li D, Wang R, Zhang R, Xu Y. Preferences and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis. Med Decis Making 2010; 31:245-53. [PMID: 20709961 DOI: 10.1177/0272989x10375990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The objectives of this study were to measure the preferences for and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis and to explore the factors that may influence patients' preferences. The study also aimed to analyze patients' satisfaction with decision and information provision and their relationships with the decisional role. METHODS Semistructured interviews were performed with 178 chronic hepatitis patients. The Control Preferences Scale was translated into Chinese from English and adopted to measure patients' preferred and perceived decisional role. Patients' satisfaction with decision and information provision was also investigated by a 5-point Likert-type scale. RESULTS Patients with chronic hepatitis in the study generally preferred a collaborative role (45%) or passive role (44%); only 11% of patients preferred an active role in treatment decision making. The agreement between patients' perceived and preferred role was not perfect (Bowker's S = 33.8, P < 0.001). Age and education level were significantly associated with patients' preferences: Younger, better educated patients tended to prefer more active roles. A total of 54% of patients felt satisfied with treatment decisions, whereas 39% of patients felt satisfied with information provision. Patients' levels of satisfaction with their treatment decisions were correlated not only with the perceived role itself but also with its agreement with the preferred role. Patients' satisfaction with information provision was significantly correlated with patients' preferred role. Moreover, there was a significant correlation between patients' satisfaction with the treatment decision and information provision. CONCLUSIONS Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and preferred decisional role.
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Affiliation(s)
- Yuhai Zhang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Haixia Su
- Department of Epidemiology (HS) Fourth Military Medical University, Xi’an, China
| | - Lei Shang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Duan Li
- Tangdu Hospital (DL) Fourth Military Medical University, Xi’an, China
| | - Rui Wang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Ruiqiao Zhang
- Sanatorium Center for Retired Cadre (RZ), Fourth Military Medical University, Xi’an, China
| | - Yongyong Xu
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
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Giordano A, Uccelli MM, Pucci E, Martinelli V, Borreani C, Lugaresi A, Trojano M, Granella F, Confalonieri P, Radice D, Solari A. The Multiple Sclerosis Knowledge Questionnaire: a self-administered instrument for recently diagnosed patients. Mult Scler 2009; 16:100-11. [PMID: 19995834 DOI: 10.1177/1352458509352865] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are few studies on patient knowledge in multiple sclerosis (MS), and only two published questionnaires. The objective of this article was to develop and validate the MS Knowledge Questionnaire (MSKQ), a self-assessed instrument for newly diagnosed MS patients. Thirty multiple-choice statements, conceived to test MS knowledge, were produced by a multidisciplinary panel and pre-tested on three MS patients, resulting in an intermediate 26-item version. This was tested on 54 MS patients for internal consistency, content and construct validity (validation sample I). The final (25-item) MSKQ was a primary outcome measure in the SIMS-Trial on an information aid to newly diagnosed MS patients. Postal responses of SIMS-Trial participants to the MSKQ a month after intervention (validation sample II) were analysed. Median MSKQ scores in validation samples I and II were, respectively, 18 (range 9-23) and 17 (range 3-24). Acceptability, internal consistency (Kuder-Richardson-20 formula 0.76) and content validity were good. Educational attainment and receiving the information aid were the main independent predictors of MS knowledge. Other predictors were female sex (positive association) and disease duration (negative association). In conclusion, the MSKQ has good clinimetric properties and is sensitive to an educational intervention. We propose the MSKQ as a brief instrument for clinical practice and research.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C Besta, Milan, Italy
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Giordano A, Mattarozzi K, Pucci E, Leone M, Casini F, Collimedaglia L, Solari A. Participation in medical decision-making: attitudes of Italians with multiple sclerosis. J Neurol Sci 2008; 275:86-91. [PMID: 18786682 DOI: 10.1016/j.jns.2008.07.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient involvement in decisions regarding their care has been advocated, but preferences have not been adequately canvassed, particularly in people with multiple sclerosis (MS). OBJECTIVES To cross-culturally adapt and validate the Italian version of the Control Preference Scale (CPS) subsequently used to assess preferences of people with MS. METHODS Translation-adaptation into Italian of CPS from the original Canadian English followed by administration in 140 people with MS from five Italian centers (with re-administration in 35) and semi-structured interview. RESULTS Cross-cultural adaptation of CPS was successful. The 140 people with MS, who varied in clinical and general characteristics, considered the CPS clear and acceptable. Test-retest reliability was moderate (weighted Kappa 0.65; p<0.001). A collaborative role was preferred (61%), followed by passive (33%) and active (6%) roles. Education (odds ratio [OR] 2.43, 95% confidence limits [CI] 1.05-5.66) and length of follow-up at referral center (OR 0.36, 95% CI 0.14-0.92) were associated with choice of an active/collaborative role in the logistic model. CONCLUSIONS The Italian CPS was well accepted by our MS population. Our data indicate that a high proportion of Italians with MS prefer a more passive role and this should be considered during the clinical encounter.
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Affiliation(s)
- Andrea Giordano
- Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy
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