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Lomer NB, Asalemi KA, Saberi A, Sarlak K. Predictors of multiple sclerosis progression: A systematic review of conventional magnetic resonance imaging studies. PLoS One 2024; 19:e0300415. [PMID: 38626023 PMCID: PMC11020451 DOI: 10.1371/journal.pone.0300415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic neurodegenerative disorder that affects the central nervous system (CNS) and results in progressive clinical disability and cognitive decline. Currently, there are no specific imaging parameters available for the prediction of longitudinal disability in MS patients. Magnetic resonance imaging (MRI) has linked imaging anomalies to clinical and cognitive deficits in MS. In this study, we aimed to evaluate the effectiveness of MRI in predicting disability, clinical progression, and cognitive decline in MS. METHODS In this study, according to PRISMA guidelines, we comprehensively searched the Web of Science, PubMed, and Embase databases to identify pertinent articles that employed conventional MRI in the context of Relapsing-Remitting and progressive forms of MS. Following a rigorous screening process, studies that met the predefined inclusion criteria were selected for data extraction and evaluated for potential sources of bias. RESULTS A total of 3028 records were retrieved from database searching. After a rigorous screening, 53 records met the criteria and were included in this study. Lesions and alterations in CNS structures like white matter, gray matter, corpus callosum, thalamus, and spinal cord, may be used to anticipate disability progression. Several prognostic factors associated with the progression of MS, including presence of cortical lesions, changes in gray matter volume, whole brain atrophy, the corpus callosum index, alterations in thalamic volume, and lesions or alterations in cross-sectional area of the spinal cord. For cognitive impairment in MS patients, reliable predictors include cortical gray matter volume, brain atrophy, lesion characteristics (T2-lesion load, temporal, frontal, and cerebellar lesions), white matter lesion volume, thalamic volume, and corpus callosum density. CONCLUSION This study indicates that MRI can be used to predict the cognitive decline, disability progression, and disease progression in MS patients over time.
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Affiliation(s)
| | | | - Alia Saberi
- Department of Neurology, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kasra Sarlak
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Wenzel L, Haker M, Heesen C, Kasper J, Köpke S, Rahn AC. Evaluating Relapse Knowledge in People with Multiple Sclerosis: A Cross-Sectional Study on the Development and Validation of the Relapse Knowledge Questionnaire. Mult Scler Relat Disord 2024; 83:105381. [PMID: 38308915 DOI: 10.1016/j.msard.2023.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) knowledge is a prerequisite for active patient engagement in medical decision-making. Treatment of relapses in MS is a clinical field with many uncertainties and each acute relapse requires decisions regarding possible options for action, indicating the need for patient involvement. However, there is no validated instrument assessing relapse knowledge in people with MS. Our study aims to develop a valid MS relapse questionnaire for use as an outcome instrument for educational interventions. METHODS A multidisciplinary panel developed the relapse knowledge questionnaire (RKQ) based on a previously developed questionnaire. We tested the RKQ on MS patients for comprehensibility, usability and acceptance in qualitative think-aloud interviews and conducted a cross-sectional quantitative online survey to validate the questionnaire. People with suspected or confirmed relapsing-remitting MS and a recent relapse experience were eligible for inclusion. We checked normal distribution of the RKQ score and determined the item difficulty. Construct validity was analysed using correlational analysis. RESULTS The final RKQ consists of 10 items. After minor changes of the RKQ during pre-testing (n = 2), pilot testing (n = 10) confirmed the usability and acceptance of the instrument. The subsequent validation study (n = 203) resulted in a mean item difficulty of 0.44, ranging from 0.18 to 0.83. Seven items were particularly difficult and answered incorrectly by more than 50 % of participants. Construct validity of the RKQ was satisfactory. The RKQ score correlated only weakly with participants' degree of education (|rp|>0.1), years since diagnosis (|rp|>0.1), and the intention to receive corticosteroids (|rp|>0.1). CONCLUSION This study indicates the validity of the RKQ and proposes that the RKQ is a suitable instrument to assess relapse knowledge in people with MS participating in educational interventions.
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Affiliation(s)
- Lisa Wenzel
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michel Haker
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph 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
| | - Jürgen Kasper
- Institute of Nursing Sciences and Health Promotion, Faculty of Health Sciences, OsloMet, Metropolitan University, Oslo, Norway
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany
| | - Anne Christin Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
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Ben-Zacharia AB, Walker B, Ross AP, Tornatore C, Edwards NC, Lipman Y, Phillips AL. Factors Associated With Disease-Modifying Therapy Adherence and Persistence in Multiple Sclerosis: A Scoping Literature Review. Int J MS Care 2023; 25:188-195. [PMID: 37720259 PMCID: PMC10503813 DOI: 10.7224/1537-2073.2021-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) receiving disease-modifying therapies (DMT) show published adherence rates of 27.0% to 93.8% and published persistence rates of 49.7% to 96.5%. Improvements in DMT adherence and persistence are key to optimizing MS care, and enhanced understanding could improve MS disease management and identify research gaps. This scoping literature review aims to examine the nature and findings of the literature evaluating factors associated with DMT adherence and persistence in patients with MS. METHODS Eligible articles included in the literature review were quantitative clinical studies written in English, included adherence or persistence as primary outcomes, and accounted for covariates/confounders. The articles were assessed to identify factors associated with adherence/persistence and analyzed according to DMT type (self-injectable, oral, infusion). RESULTS Fifty-eight studies (103,450 patients) were included. Study distribution by DMT type was self-injectable only (n = 41), oral only (n = 2), infusion only (n = 1), and more than 1 type (n = 14). Older age and previous DMT use were associated with increased adherence and/or persistence. Increased alcohol consumption, DMT adverse events, higher education, and higher body mass index were negatively associated with adherence and/or persistence. Greater number and severity of relapses was associated with increased adherence but decreased persistence. CONCLUSIONS Most studies examined factors associated with adherence and persistence to self-injectable DMTs. These factors should be evaluated further for oral and infusion DMTs. Insights into the modifiable factors associated with adherence and persistence could guide treatment decisions and help improve adherence and clinical outcomes.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- From Bellevue School of Nursing, Hunter College, New York, NY, USA (AB-Z)
- Mount Sinai Medical Center, New York, NY, USA (AB-Z)
| | - Bryan Walker
- Duke University School of Medicine, Durham, NC, USA (BW)
| | | | - Carlo Tornatore
- Medstar Georgetown University Hospital, Washington, DC, USA (CT)
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Ben-Zacharia AB, Lee JM, Kahle JS, Lord B. Shared decision-making in multiple sclerosis physical symptomatic care: a systematic review. Ther Adv Chronic Dis 2023; 14:20406223231172920. [PMID: 37324408 PMCID: PMC10265321 DOI: 10.1177/20406223231172920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic autoimmune inflammatory, demyelinating, and neurodegenerative disease affecting young adults. People with MS are highly interested in engaging in physical symptom management and decision-making but are often not actively engaged in symptom management discussions. Research examining the benefit of shared decision-making in the management of physical MS symptoms is sparse. Objectives This study aimed to identify and synthesize the evidence on the use of shared decision-making in physical MS symptom management. Design This study is a systematic review of published evidence on the use of shared decision-making in physical MS symptom management. Data sources and methods MEDLINE, CINAHL, EMBASE, and CENTRAL databases were searched in April 2021, June 2022, and April 2, 2023, for primary, peer-reviewed studies of shared decision-making in the management of MS physical symptoms. Citations were screened, data extracted, and study quality assessed according to Cochrane guidelines for systematic reviews, including risk of bias assessment. Statistical synthesis of the included study results was not appropriate; results were summarized in a nonstatistical manner using the vote-counting method to estimate beneficial versus harmful effects. Results Of 679 citations, 15 studies met the inclusion criteria. Six studies addressed shared decision-making in the management of pain, spasms, neurogenic bladder, fatigue, gait disorder, and/or balance issues, and nine studies addressed physical symptoms in general. One study was a randomized controlled trial; most studies were observational studies. All study results and study author conclusions indicated that shared decision-making is important to the effective management of physical MS symptoms. No study results suggested that shared decision-making was harmful or delayed the management of physical MS symptoms. Conclusion Reported results consistently indicate that shared decision-making is important in effective MS symptomatic care. Further rigorous randomized controlled trials are warranted to investigate the effectiveness of shared decision-making associated with MS physical symptomatic care. Registration PROSPERO: CRD42023396270.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Assistant Professor, Hunter Bellevue School of Nursing, 425 East 25 Street, New York, NY 10010, USA
- Mount Sinai Hospital, New York, NY, USA
| | - Jong-Mi Lee
- Neuroscience Clinic, Stanford Health Care, CA, USA
| | - Jennifer S. Kahle
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- IHS International, San Diego, CA, USA
| | - Bonnie Lord
- A patient living with multiple sclerosis since 2003
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Patti F, Chisari CG, Toscano S, Annovazzi P, Banfi P, Bergamaschi R, Clerici R, Conti MZ, Cortese A, Fantozzi R, Ferraro D, Fischetti M, Frigo M, Gatto M, Immovilli P, Leoni S, Malucchi S, Maniscalco G, Marfia GA, Paolicelli D, Perini P, Serrati C, Totaro R, Turano G, Valentino P, Zaffaroni M, Zuliani C, Centonze D. Patients with multiple sclerosis choose a collaborative role in making treatment decision: results from the Italian multicenter SWITCH study. Mult Scler Relat Disord 2023; 70:104474. [PMID: 36584654 DOI: 10.1016/j.msard.2022.104474] [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: 09/27/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinicians are increasingly recognizing the importance of shared decision-making in complex treatment choices, highlighting the importance of the patient's rationale and motivation for switching therapies. This study aimed to evaluate the association between different modalities of changing multiple sclerosis (MS) treatments, cognitive profile and attitude and preferences of patients concerning treatment choice. METHODS This multicenter cross-sectional study was conducted at 28 Italian MS centers in the period between June 2016 and June 2017. We screened all MS patients treated with any DMT, with a treatment compliance of at least 80% of therapy administered during the 3 last months who needed to modify MS therapy because of efficacy, safety or other reasons during a follow-up visit. At the time of switching the symbol digit modalities test (SDMT) and the Control Preference Scale (CPS) were evaluated. According to the CPS, patients were classified as "active" (i.e. who prefer making the medical decision themselves), "collaborative" (i.e. who prefer decisions be made jointly with the physician), or "passive" (i.e. who prefer the physician make the decision). RESULTS Out of 13,657 patients recorded in the log, 409 (3%) changed therapy. Of these, 336 (2.5%) patients, 69.6% were female and with mean age 40.6 ± 10.5 years, were enrolled. According to the CPS score evaluation, a significant high percentage of patients (51.1%) were considered collaborative, 74 patients (22.5%) were passive, and 60 (18.2%) patients were active. Stratifying according to CPS results, we found a higher SDMT score among collaborative patients compared to active and passive ones (45.8 ± 12.3 versus 41.0 ± 13.2 versus 41.7 ± 12.8, p < 0.05). CONCLUSION In this study, the CPS evaluation showed that more than 50% of patients who needed to change therapy chose a "collaborative" role in making treatment decision. Cognitive profile with SDMT seems to correlate with patients' preference on treatment decision, showing better scores in collaborative patients.
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Affiliation(s)
- Francesco Patti
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, via S. Sofia 78, Catania 95129, Italy.
| | - Clara Grazia Chisari
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, via S. Sofia 78, Catania 95129, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, Hospital of Gallarate - ASST della Valle Olona, Gallarate, Italy
| | - Paola Banfi
- Operative Unit of Neurology and Stroke Unit, Varese, Italy
| | | | | | | | - Antonio Cortese
- Department of Human Neurosciences, Sapienza, University of Rome, Italy
| | | | - Diana Ferraro
- Department of Neuroscience, UO of Neurology, AOU Policlinico OB, Modena, Italy
| | | | - Maura Frigo
- Neurology Department, San Gerardo Hospital, Monza, Italy
| | - Maurizia Gatto
- Department of Neurology, General Regional Hospital "Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | | | - Simona Malucchi
- SCDO Neurologia-CRESM, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Girolama Alessandra Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, "Tor Vergata" University, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Perini
- Multiple Sclerosis Center, Neurological Clinic, University Hospital of Padua, Italy
| | - Carlo Serrati
- Operative Unit of Neurology and Stroke Unit, IRCCS Hospital San Martino, Genoa, Italy
| | - Rocco Totaro
- Department of Neurology, Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Gabriella Turano
- Department of Neurology, Mondovì General Hospital, Local Health Authority CN1, Mondovì, Cuneo, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST della Valle Olona, Gallarate, Italy
| | | | - Diego Centonze
- Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy; Unit of Neurology - IRCCS Neuromed, Pozzilli, Isernia, Italy.
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Cimino V, Chisari CG, Toscano S, Patti F. Palliative care in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:129-138. [PMID: 36599504 DOI: 10.1016/b978-0-12-824535-4.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Main target in palliative care (PC) is burden care of patients and their families, with the aim to reduce suffering through the management of symptoms, rehabilitation, psychosocial issues, and spiritual well-being, using a multidisciplinary approach. Multiple sclerosis (MS) is a chronic disease which induces physical and psychosocial symptoms, with a significant impact on the quality of life. As a consequence, despite advances in research in disease-modifying drugs, MS remains a life-limiting disease with symptoms negatively impacting the lives of MS patients and their families. PC has been developed for end-of-life treatment in oncology, being little used in MS. Specific issues in MS, like pain due to spasticity, requires a different approach respect to cancer pain management. Moreover, it is difficult to anticipate life expectancy in people with severe MS, who often need palliative care for a long extended period. PC teams are trained to keep open full and competent lines of communication about symptoms and disease progression, advanced care planning, and end-of-life issues and wishes. Many studies investigated the effects of home-based PC in advanced MS, showing weak evidences about the efficacy of PC versus usual care in MS. However, current evidence does not support or refute the routine use of PC interventions for people with MS.
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Affiliation(s)
- Vincenzo Cimino
- Rehabilitation Division, Centro Neurolesi "Bonino Pulejo", IRCSS, Messina, Italy
| | - Clara Grazia Chisari
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy
| | - Simona Toscano
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy
| | - Francesco Patti
- Department G.F. Ingrassia, Section of Neuroscience, University of Catania, Catania, Italy.
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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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Shosha E, Burton JM. Discussing the potential for progression with patients newly diagnosed with multiple sclerosis: When, how, and why? Mult Scler Relat Disord 2022; 68:104230. [PMID: 36240704 DOI: 10.1016/j.msard.2022.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Despite convergent evidence that upwards of 50% of patients with MS transition from a relapsing to progressive phase within 20 years of disease onset, and the recent acknowledgement of the commonality of progression independent of relapses, there remains no consensus regarding the nature and timing of a discussion about the possibility of a secondary progressive phase with relapsing-remitting MS patients. Some neurologists prefer to conduct this at the inaugural visit to provide more information about disease behaviour and potential planning that might entail, while others may defer any discussion about this phase, as there is no clear consensus for it and it can be a sensitive topic, with concern that too early a discussion could worsen anxiety and discourage or delay decisions regarding disease modifying treatments. Furthermore, it is unknown at onset which patients will transition to a progressive phenotype. This review and opinion paper will outline some of the opportunities and challenges associated with such a disclosure, and attempt to provide a balanced, patient-centred approach to address this delicate topic.
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Affiliation(s)
- Eslam Shosha
- Neurology division, Department of Medicine, McMaster University, Hamilton Health Science Center, 237 Barton st, E, Room 436, Hamilton, ON L8L 2X2, Canada.
| | - Jodie M Burton
- Department of clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Canada
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Wenzel L, Heesen C, Peper J, Grentzenberg K, Faßhauer E, Scheiderbauer J, Thale F, Meyer B, Köpke S, Rahn AC. An interactive web-based programme on relapse management for people with multiple sclerosis (POWER@MS2) - development, feasibility, and pilot testing of a complex intervention. Front Neurol 2022; 13:914814. [PMID: 36212638 PMCID: PMC9538652 DOI: 10.3389/fneur.2022.914814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/05/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Despite the lack of high-quality evidence regarding its long-term effectiveness, intravenous corticosteroid therapy is recommended as the standard treatment of acute multiple sclerosis relapses in Germany. High financial expenses and the equivalent effectiveness of oral corticosteroid therapy contrast with this trend. There is an urgent need to provide patients with evidence-based and comprehensible information on relapse management and to actively involve patients in relapse treatment decisions. Web-based decision support on relapse management could be an effective measure to empower people with multiple sclerosis making informed treatment decisions. Objectives To develop a web-based programme on relapse management for people with multiple sclerosis and evaluate the feasibility and acceptability of the intervention. Methods The study followed the first two phases of the UK Medical Research Council Framework for complex interventions. The first phase involved the development of an interactive web-based programme on relapse management. The second phase focused on the feasibility and pilot testing of the programme with people with multiple sclerosis and experts with a professional background in multiple sclerosis. Data was obtained using questionnaires with closed- and open-ended questions as well as qualitative semi-structured telephone interviews. Quantitative data was analyzed descriptively, whereas qualitative data was clustered by topic. Results Feasibility of the intervention programme was tested with 10 people with multiple sclerosis and 10 experts. Feasibility testing indicated good practicability and acceptance of the content. After revision, the programme was piloted with seven people with multiple sclerosis and three experts. The results showed good acceptance in both groups. Based on the feedback, a final revision was performed. Conclusion Feasibility and pilot testing indicated good user-friendliness, acceptance, and practicability of the programme. The programme is currently evaluated in a randomized controlled trial (Registration Number on ClinicalTrials.gov: NCT04233970). It is expected that the programme will have a positive impact on patients' relapse management and strengthen their autonomy and participation.
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Affiliation(s)
- Lisa Wenzel
- Medical Faculty and University Hospital Cologne, Institute of Nursing Science, University of Cologne, Cologne, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Lisa Wenzel
| | - Christoph 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
| | - Julia Peper
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Kristina Grentzenberg
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edeltraud Faßhauer
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V., Hannover, Germany
| | | | | | | | - Sascha Köpke
- Medical Faculty and University Hospital Cologne, Institute of Nursing Science, University of Cologne, Cologne, Germany
| | - Anne Christin 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
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Becker C, Gross S, Gamp M, Beck K, Amacher SA, Mueller J, Bohren C, Blatter R, Schaefert R, Schuetz P, Leuppi J, Bassetti S, Hunziker S. Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial. J Gen Intern Med 2022; 38:1180-1189. [PMID: 36085211 PMCID: PMC10110786 DOI: 10.1007/s11606-022-07775-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge. OBJECTIVE We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay). DESIGN This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals. PARTICIPANTS Adult patients that were hospitalized for inpatient care. MAIN MEASURES The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round. KEY RESULTS Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, - 5.08 [95% CI, - 8.69 to - 1.48 points], p = 0.006) and in nurses (adjusted difference, - 3.41 [95% CI, - 6.51 to - 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, - 7.17 [95% CI, - 11.01 to - 3.34 points], p < 0.001). CONCLUSION Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care. TRIAL REGISTRATION ClinicalTrials.gov (NCT03210987).
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Affiliation(s)
- Christoph Becker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Martina Gamp
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Katharina Beck
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Simon A Amacher
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Jonas Mueller
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Chantal Bohren
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - René Blatter
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Rainer Schaefert
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Joerg Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland. .,Faculty of Medicine, University of Basel, Basel, Switzerland.
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11
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Steinberg L, Peper J, Köpke S, Solari A, Giordano A, Gold SM, Hellwig K, Heesen C, Rahn AC. Motherhood choice in multiple sclerosis (MoMS) development and piloting of patient-reported outcome measures. Mult Scler Relat Disord 2022; 63:103831. [DOI: 10.1016/j.msard.2022.103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
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12
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Chavez-Tapia NC, Barrientos-Gutierrez T, Torres-Ibarra L, Sanchez-Jiménez B, Juarez-Hernandez E, Ramos-Ostos M, Alva-Lopez LF, Uribe M. Incremental levels of diagnostic information incentivize health-seeking in non-alcoholic fatty liver: a randomized clinical trial. Sci Rep 2022; 12:8272. [PMID: 35585153 PMCID: PMC9117664 DOI: 10.1038/s41598-022-12295-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m2. There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).
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Affiliation(s)
- Norberto C Chavez-Tapia
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico.
| | | | - Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Beatriz Sanchez-Jiménez
- Gastroenterology Department, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eva Juarez-Hernandez
- Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Martha Ramos-Ostos
- Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Luis F Alva-Lopez
- Radiology and Medical Imaging Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico
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13
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Multiple sclerosis disease-related knowledge measurement instruments show mixed performance: a systematic review. J Clin Epidemiol 2022; 149:60-82. [DOI: 10.1016/j.jclinepi.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
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14
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Development and evaluation of a website with patients experiences of multiple sclerosis: a mixed methods study. BMC Neurol 2022; 22:146. [PMID: 35443631 PMCID: PMC9019288 DOI: 10.1186/s12883-022-02663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. METHODS A mixed-methods approach was applied. A total of 69 participants visited the German "Patient Experiences with MS (PExMS)" website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people's experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. CONCLUSIONS The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.
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15
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Freund M, Schiffmann I, Rahn AC, Chard D, Lukas C, Scheiderbauer J, Sippel A, Heesen C. Understanding Magnetic Resonance Imaging in Multiple Sclerosis (UMIMS): Development and Piloting of an Online Education Program About Magnetic Resonance Imaging for People With Multiple Sclerosis. Front Neurol 2022; 13:856240. [PMID: 35418941 PMCID: PMC8996193 DOI: 10.3389/fneur.2022.856240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background People with multiple sclerosis (pwMS) lack sufficient magnetic resonance imaging (MRI) knowledge to truly participate in frequently occurring MRI-related therapy decisions. An evidence-based patient information (EBPI) about MRI is currently lacking. Objective The aim of this study was to develop an evidence-based online education program about limitations and benefits of MRI for pwMS. Ultimately, our goal was to improve MRI risk-knowledge, empower pwMS, and promote shared decision-making. Methods The program's contents were based on literature research and a previous pilot study. It was revised following 2 evaluation rounds with pwMS, MRI experts and expert patients. In a pilot study, n = 92 pwMS received access to the program for 4 weeks. User experiences and acceptance, MRI knowledge (MRI-RIKNO 2.0 questionnaire) and emotions and attitudes toward MRI (MRI-EMA questionnaire) were assessed. Results were compared to a previous survey population of n = 508 pwMS without access to the program. Results Participants rated the program as easy to understand, interesting, relevant, recommendable, and encouraging. In comparison to pwMS without access to the program, MRI risk-knowledge and perceived MRI competence were higher. Conclusion Satisfaction with the program and good MRI-risk knowledge after usage demonstrates the need and applicability of EBPI about MRI in MS.
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Affiliation(s)
- Magalie Freund
- Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Insa Schiffmann
- Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre, London, United Kingdom
| | - Carsten Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jutta Scheiderbauer
- Foundation for Self-Determination and Self-Representation for People With MS, Trier, Germany
| | - Anna Sippel
- Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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16
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Schneider A, Fasshauer E, Scheiderbauer J, Warnke C, Köpke S, Kasper J, Toussaint M, Temmes H, Hemmer B, Schiffmann I, Rahn A, Heesen C. Development and evaluation of evidence-based patient information handbooks about multiple sclerosis immunotherapies. Mult Scler Relat Disord 2022; 60:103728. [DOI: 10.1016/j.msard.2022.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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17
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Nordfalk JM, Holmøy T, Thomas O, Nylenna M, Gulbrandsen P. Training physicians in providing complex information to patients with multiple sclerosis: a randomised controlled trial. BMJ Open 2022; 12:e049817. [PMID: 35292486 PMCID: PMC8928319 DOI: 10.1136/bmjopen-2021-049817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a specific communication training for neurologists on how to provide complex information about treatment options to patients with multiple sclerosis (MS). DESIGN Single-centre, single-blind, randomised controlled trial. SETTING One university hospital in Norway. PARTICIPANTS Thirty-four patients with early-stage MS. INTERVENTION A 3-hour training for neurologists on how to provide complex information about MS escalation therapy. MAIN OUTCOME MEASURES Patient recall rate, measured with a reliable counting system of provided and recalled information about drugs. SECONDARY OUTCOME MEASURES Number of information units provided by the physicians. Effects on patient involvement through questionnaires. METHODS Patients with MS were instructed to imagine a disease development and were randomised and blinded to meet a physician to receive information on escalation therapy, before or after the physician had participated in a 3-hour training on how to provide complex information. Consultations and immediate patient recall interviews were video-recorded and transcribed verbatim. RESULTS Patient recall rate was 0.37 (SD=0.10) pre-intervention and 0.39 (SD=0.10) post-intervention. The effect of the intervention on recall rate predicted with a general linear model covariate was not significant (coefficient parameter 0.07 (SE 0.04, 95% CI (-0.01 to 0.15)), p=0.099).The physicians tended to provide significantly fewer information units after the training, with an average of 91.0 (SD=30.3) pre-intervention and 76.5 (SD=17.4) post-intervention; coefficient parameter -0.09 (SE 0.02, 95% CI (-0.13 to -0.05)), p<0.001. There was a significant negative association between the amount of provided information and the recall rate (coefficient parameter -0.29 (SE 0.05, 95% CI (-0.39 to -0.18)), p<0.001). We found no significant effects on patient involvement using the Control Preference Scale, Collaborate or Four Habits Patient Questionnaire. CONCLUSION A brief course for physicians on providing complex information reduced the amount of information provided, but did not improve patient recall rate. TRIAL REGISTRATION NUMBER ISRCTN42739508.
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Affiliation(s)
- Jenny M Nordfalk
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
- Department of Neurology, Akershus University Hospital Neuroclinic, Lørenskog, Norway
| | - Owen Thomas
- Health Services Research Unit HØKH, Akershus University Hospital, Lørenskog, Norway
| | - Magne Nylenna
- Institute of Health and Society, Norwegian Institute of Public Health, Oslo, Norway
| | - Pal Gulbrandsen
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
- Health Services Research Unit HØKH, Akershus University Hospital, Lørenskog, Norway
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18
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Evaluation of a national programme to improve shared decision-making skills among junior medical doctors in Denmark: a mixed methods study of satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. BMC Health Serv Res 2022; 22:245. [PMID: 35197065 PMCID: PMC8867664 DOI: 10.1186/s12913-022-07639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background Shared decision-making (SDM) is a cornerstone in patient-centred care and there has been an increase in programmes aiming to improve clinicians’ abilities to engage in it. However, the evidence for such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus on satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This is a mixed methods study, consisting of an online survey followed by semi-structured interviews. The participants were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed it, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded, and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience as junior doctors, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusions Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added, while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07639-6.
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19
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Magnetic Resonance Imaging as a Prognostic Disability Marker in Clinically Isolated Syndrome and Multiple Sclerosis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12020270. [PMID: 35204361 PMCID: PMC8871297 DOI: 10.3390/diagnostics12020270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.
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20
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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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21
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Sippel A, Riemann-Lorenz K, Scheiderbauer J, Kleiter I, Morrison R, Kofahl C, Heesen C. Patients experiences with multiple sclerosis disease-modifying therapies in daily life - a qualitative interview study. BMC Health Serv Res 2021; 21:1141. [PMID: 34686166 PMCID: PMC8539738 DOI: 10.1186/s12913-021-07012-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/07/2021] [Indexed: 01/26/2023] Open
Abstract
Background Besides coping with a disease with many uncertainties, people with relapsing-remitting multiple sclerosis face complex decisions concerning disease-modifying therapies (DMTs). In an interview study, we aimed to assess patients’ experiences with DMTs. Methods Problem-centred interviews were conducted with 50 people with relapsing-remitting multiple sclerosis in Germany using maximum variation sampling and covering all licensed DMTs. Data were analysed thematically using deductive and inductive categories. Results 47 of 50 patients had treatment with at least one of the approved DMTs. The main themes were: (1) starting a DMT, (2) switching to another DMT, (3) discontinuing a DMT, and (4) multiple sclerosis without starting a DMT. Different intercorrelated factors influenced the decision-making processes for or against a DMT. Individual experiences with DMTs in daily life contained the effort in administration, success, and failure of DMTs, coping strategies and well-being without DMTs. The decision-making process for or against a DMT and the use of those treatments can be understood as a constant, continually shifting process, complicated by different factors, which change over time. Experiences with DMTs were characterized by attempts to handle uncertainty and to (re)gain control and integrate adaptivity into one’s life. Conclusions The study provides a rich and nuanced amount of patients’ experiences with DMTs. The findings demonstrate the importance for practitioners to look at current life circumstances of patients with multiple sclerosis when recommending a DMT and to promote and enable patients to make informed decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07012-z.
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Affiliation(s)
- Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - Christopher Kofahl
- Patient representative, Trier, Hamburg, Germany.,Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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22
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Bansback N, Chiu JA, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Traboulsee A, Lynd LD, Carruthers R. Preliminary testing of a patient decision aid for patients with relapsing-remitting multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211029966. [PMID: 34350027 PMCID: PMC8287362 DOI: 10.1177/20552173211029966] [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] [Received: 01/22/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multiple first-line disease modifying therapies (DMTs) are available for
relapsing-remitting multiple sclerosis (RRMS), each with different
characteristics. We developed an interactive patient decision aid (PtDA) to
promote informed shared decision-making (SDM). Objective To test the preliminary effectiveness of the PtDA in participants with
RRMS. Methods Knowledge, and decisional conflict were measured pre- and post-
implementation of the PtDA, SDM after the consultation, and 6-month
treatment patterns were observed. Differences in scores were analyzed using
descriptive statistics and paired t-tests. Qualitative interviews with
patients and neurologists were analyzed using thematic analysis. Results 52 participants were recruited: most were female (81%), 40 years of age or
younger (62%), and had experienced MS for less than 5 years (56%). After
participants used the PtDA, there was a significant improvement in
decisional conflict (change = 1.00; p < 0.001) and
knowledge (change = 2.15, p < 0.001). Nearly all patients wanted SDM, and
25 (56%) reported this occurred in their consult. Qualitative results
suggested the PtDA supported both patients and neurologists in making
decisions. Conclusion This pilot study suggests that PtDA use helps RRMS patients and their
clinician select a DMT. Future studies will assess the feasibility of
implementation and the impact of the PtDA on timely DMT initiation and
longer-term adherence.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Judy A Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Alice Schabas
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | | | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Vancouver, Canada
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23
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Bessing B, Honan CA, van der Mei I, Taylor BV, Claflin SB. Development and psychometric properties of the Multiple Sclerosis Knowledge Assessment Scale: Rasch analysis of a novel tool for evaluating MS knowledge. Mult Scler 2021; 27:767-777. [PMID: 33739199 DOI: 10.1177/1352458520929626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS)-related knowledge is an important evaluation metric for health education interventions. However, few MS knowledge assessment tools are currently available for use. OBJECTIVES This study aims to develop a reliable and valid Multiple Sclerosis Knowledge Assessment Scale (MSKAS) for use in the MS community and the general public. METHODS The MSKAS was developed using a Delphi study methodology and was administered to participants in the first open enrolment of the Understanding Multiple Sclerosis (UMS) online course. Rasch analysis was used to examine its psychometric properties and develop the final scale. RESULTS Experts from across the MS community participated in the development of the MSKAS, resulting in an initial scale of 42 items. Five hundred and forty-three UMS participants completed the MSKAS; 89% were female and 30% were people with MS. The final unidimensional 22-item scale has a person separation index of 2.16, a person reliability index of 0.82, an item separation index of 11.19, and a Cronbach's alpha (kr-20) test reliability of 0.87. CONCLUSION The MSKAS is a unidimensional scale with good construct validity and internal consistency. The MSKAS has the potential to be useful for the assessment of MS knowledge in research and clinical practice.
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Affiliation(s)
- Barnabas Bessing
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Cynthia A Honan
- Division of Psychology, School of Medicine, University of Tasmania, Launceston, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Patients and neurologists have different perceptions of multiple sclerosis symptoms, care and challenges. Mult Scler Relat Disord 2021; 50:102806. [PMID: 33588316 DOI: 10.1016/j.msard.2021.102806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Basic steps in the management of patients with Multiple Sclerosis (MS), such as good patient understanding of the disease and active participation in its management are extremely important, as they directly influence treatment adherence and success. Therefore, this study aimed to evaluate the perception of MS patients and neurologists pertaining to the most common disease symptoms, disabilities that impact on quality of life, and patient concerns and difficulties during medical visits, as information that can be used to improve the doctor-patient relationship. METHODS A cross-sectional study involving two groups: the first composed of neurologists and the second of patients. Participants of the first group were selected by a Steering Committee (15 predetermined neurologists representing each region of Brazil and specialized in MS and neuroimmunological disorders, who also assumed the role of creating the survey and questionnaire). Participants of the second group were selected following dissemination of a questionnaire on the AME's social networks (Amigos Múltiplos pela Esclerose, a non-governmental organization to support patients with MS). Questions about sociodemographic data, disease impact on quality of life, symptoms perception, and concerns and issues regarding disease care were put to both groups. RESULTS A total of 317 patients and 182 neurologists answered the questionnaires. Significant divergences were found between the perceptions of patients and neurologists in relation to orientation and information given during medical appointments, and also regarding patient participation in treatment and therapy choice. Considering the topic assessing impact on quality of life, more than 70% of neurologists perceived that autonomy to work and travel, and future planning were aspects that most affected patient lives, however, almost 50% of patients reported that disease monitoring did not affect their life in any way. Analysis of data regarding MS symptoms revealed neurologists to consider physical symptoms, such as ambulation issues, imbalance, falls and urinary incontinence, to be those most interfering with patient quality of life, whereas patients considered non-physical symptoms, such as fatigue, pain, cognitive and memory problems to be more significant. Patients with primary progressive MS complained more about ambulation issues, imbalance and falls (p<0.05), when compared to patients with other disease phenotypes. CONCLUSION Significant differences in disease perception were found in this study. While neurologists tended to overestimate the consequences and symptoms of the disease, for most patients, the disease impact on activities did not appear to be as significant, with more complaints regarding non-physical symptoms. Although neurologists described involving patients in treatment decisions and providing them with appropriate orientation during medical appointments, the opposite was reported by patients. These results may help to improve treatment adherence and disease outcomes by redefining the doctor-patient relationship.
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Barabasch A, Riemann-Lorenz K, Kofahl C, Scheiderbauer J, Eklund D, Kleiter I, Kasper J, Köpke S, Lezius S, Zapf A, Rahn AC, Heesen C. Impact of a multimedia website with patient experiences of multiple sclerosis (PExMS) on immunotherapy decision-making: study protocol for a pilot randomised controlled trial in a mixed-methods design. Pilot Feasibility Stud 2021; 7:16. [PMID: 33413658 PMCID: PMC7788927 DOI: 10.1186/s40814-020-00749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background A variety of management options (e.g. immunotherapies, lifestyle interventions, and rehabilitation) are available for people with relapsing-remitting multiple sclerosis (RRMS). Besides coping with the diagnosis, people with MS (pwMS) have to make complex decisions such as deciding about immunotherapies. In addition to factual information, reports of patient experiences (PEx) may support patients in decision-making. The added value of PEx in decision-making is not clear, and controlled studies are rare. Therefore, systematic methods are necessary to develop and analyse PEx. As there are no evaluated PEx for MS in Germany, we are currently creating a website presenting PEx structured according to topics and illustrated by video, audio, and text files. We aim to determine the feasibility of an intervention using PEx and evaluate whether PEx may help pwMS in their immunotherapy decision-making processes as a supplement to evidence-based information. Methods This project will follow the Medical Research Council framework for development and evaluation of complex interventions. After the development of a website with PEx, a randomised controlled pilot trial (pilot RCT) will be conducted in 2–3 MS centres, clinics, or rehabilitation centres including 55 pwMS and accompanied by a process evaluation. Patients with a RRMS diagnosis considering immunotherapy are eligible. The primary outcome is decision self-efficacy. Secondary outcomes include preparation for decision-making, decisional conflict, risk knowledge, confidence in active participation, affective forecasting, social support, and self-reported impact of eHealth on its users. Participants will be randomly assigned either to (i) an intervention group with 4 weeks access to an evidence-based patient information resource and the PExMS-website as an adjunct or to (ii) the control group with access to evidence-based information alone. A 6-member advisory panel involving representatives of pwMS, researchers, and neurologists, who accompany the whole project, will mentor this pilot RCT. Discussion The intervention was developed with systematic methods, created with active patient involvement and in critical appraisal by an expert advisory panel. The study is innovative as it contributes to the controversial evidence on the use of PEx in the context of evidence-based patient information. Trial registration ClinicalTrials.gov, NCT04236544 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00749-0.
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Affiliation(s)
- Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Patient representative, Hamburg, Trier, Germany
| | | | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, OsloMET, Oslo Metropolitan University, Oslo, Norway
| | - Sascha Köpke
- Institute for Clinical Nursing Science, University of Cologne, Cologne, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Andreu-March M, Aguas Compaired M, Pons Busom M, Mariño EL, Modamio P. Development and Validation of the Hospital Outpatients' Information Needs Questionnaire (HOINQ). Patient Prefer Adherence 2021; 15:653-664. [PMID: 33824581 PMCID: PMC8018371 DOI: 10.2147/ppa.s280816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The main objective was to develop and validate a "Hospital Outpatients' Information Needs Questionnaire" (HOINQ). Secondly, to identify patients' preferred sources of information. Finally, to establish differences depending on the disease, as well as between sociodemographic and clinical variables. PATIENTS AND METHODS This is a transversal study based on a questionnaire. All adult hospital outpatients' who collected their medication at the Pharmacy Service were consecutively recruited, regardless of their diagnosis time, treatment or disease. The Spanish version of the internationally validated European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC QLQ-25) aimed at oncology patients was used as the starting point. In order to be applicable on new target population, it was crucial to make several changes and ensure that it complies with the validity, viability and reliability criteria. The questionnaire prepared for validation was then obtained by a literature review (face validity), submitting the EORTC QLQ-25 to an expert committee (content validity), by piloting (viability) and Cronbach's alpha statistical analysis (reliability). Once the questionnaire was completed, Cronbach's alpha of the final study (reliability) and factor analysis (construct validity) were performed. Then, pertinent modifications were applied to obtain the HOINQ. RESULTS A total of 153 outpatients filled the questionnaire, which was widely accepted and required 5-10 min to complete. Cronbach's alpha coefficients met criteria >0.7. Three factors were established by factor analysis: aspects about the disease, pharmacological and no-pharmacological treatment and satisfaction and perception of the information received. Participants felt satisfied (41-52%) with the information amount, quality and usefulness, although 1 out of 3 stated wanting to know more about the different information areas. Younger patients (P-value <0.05) and those who had been attending the Pharmacy Service for a longer time span (P-value <0.01) reported receiving more information. On a 0 to 7 scale, medical specialists (mean = 6.28, SD = 1.38) followed by the rest of health care professionals (mean = 4.23-4.63, SD = 2.25-2.29) were selected as the preferred sources of information. HIV patients reported being more informed, while those with rheumatoid arthritis felt less informed (P-value <0.05). CONCLUSION The HOINQ was developed. It is a self-completed questionnaire, composed of three blocks: the 16-item information needs questionnaire, demographic and clinical variables, and patients' preferred sources of information. It is an easy tool to use and replicate, both for patients and professionals.
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Affiliation(s)
- Mònica Andreu-March
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain
| | - Margarita Aguas Compaired
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain
- Pharmacy Service, University Hospital Sagrat Cor, Barcelona, 08029, Spain
| | - Montserrat Pons Busom
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain
- Pharmacy Service, University Hospital Sagrat Cor, Barcelona, 08029, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, 08028, Spain
- Correspondence: Pilar Modamio Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII, 27-31, Barcelona, 08028, SpainTel/Fax +34 934024544 Email
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A realist review of advance care planning for people with multiple sclerosis and their families. PLoS One 2020; 15:e0240815. [PMID: 33064749 PMCID: PMC7567361 DOI: 10.1371/journal.pone.0240815] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Advance care planning (ACP) is reported to improve the quality of outcomes of care among those with life-limiting conditions. However, uptake is low among people living with multiple sclerosis (MS) and little is known about why or how people with MS engage in this process of decision-making. Aims To develop and refine an initial theory on engagement in ACP for people with MS and to identify ways to improve its uptake for those who desire it. Methods Realist review following published protocol and reporting following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multi-disciplinary team searched MEDLINE, PsychInfo, CINAHL, Scopus, Web of Science, Embase, Google Scholar in addition to other sources from inception to August 2019. Quantitative or qualitative studies, case reports, and opinion or discussion articles related to ACP and/or end of life discussions in the context of MS were included, as well as one article on physical disability and one on motor neuron disease, that contributed important contextual information. Researchers independently screened abstracts and extracted data from full-text articles. Using abductive and retroductive analysis, each article was examined for evidence to support or refute ‘context, mechanism, and outcome’ (CMO) hypotheses, using the Integrated Behaviour Model to guide theory development. Quality was assessed according to methodological rigour and relevance of evidence. Those studies providing rich descriptions were synthesised using a realist matrix to identify commonalities across CMO configurations. Results Of the 4,034 articles identified, 33 articles were included in the synthesis that supported six CMO hypotheses that identified contexts and mechanisms underpinning engagement in ACP for people with MS and included: acceptance of their situation, prior experiences, confidence, empowerment, fear (of being a burden, of death and of dying) and the desire for autonomy. Acceptance of self as a person with a life-limiting illness was imperative as it enabled people with MS to see ACP as pertinent to them. We identified the context of MS—its long, uncertain disease trajectory with periods of stability punctuated by crisis—inhibited triggering of mechanisms. Similarly, the absence of skills and confidence in advanced communication skills among health professionals prevented possibilities for ACP discussions taking place. Conclusion Although mechanisms are inhibited by the context of MS, health professionals can facilitate greater uptake of ACP among those people with MS who want it by developing their skills in communication, building trusting relationships, sharing accurate prognostic information and sensitively discussing death and dying.
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Nasseri NN, Ghezelbash E, Zhai Y, Patra S, Riemann-Lorenz K, Heesen C, Rahn AC, Stellmann JP. Feasibility of a smartphone app to enhance physical activity in progressive MS: a pilot randomized controlled pilot trial over three months. PeerJ 2020; 8:e9303. [PMID: 32612882 PMCID: PMC7319035 DOI: 10.7717/peerj.9303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with chronic progressive multiple sclerosis (CPMS) have limited options in medical treatment. Enhancing physical activity (PA) might promote neuroregeneration in multiple sclerosis (MS) and positively influence disability, thus providing an alternative to medical treatment. Previous studies indicate that evidence-based patient information (EBPI) is essential for inducing behavioral change, e.g. enhancing PA. OBJECTIVE To investigate feasibility of a smartphone app providing EBPI about the benefit of PA and a simple activity feedback to enhance PA in people with CPMS in a pilot randomized controlled trial over 3 months. METHODS Thirty-eight people with CPMS (mean age 51 years, median Expanded Disability Status Scale 4.0) were 1:1 randomized into either a control group (n = 20) or an intervention group (n = 18). The intervention group received access to a multimedia EBPI app including activity feedback, texts, figures and videos. In the control group, participants received a leaflet with unspecific information about exercising in general. The EPBI itself was designed based on a systematic review. At baseline and after 3 months, all participants underwent clinical performance tests, filled in questionnaires and received an activity monitor (Actigraph®) for 7 days. The primary endpoint was the rate of responders defined as participants with a 20% increase of physical acitivity (time of moderate or vigiorous PA-MVPA) or 20% increase of the number of steps, both assessed with the activity monitor. As secondary endpoints, we compared accelerometry, performance and questionnaires adjusted for baseline measurments between the groups (ANCOVA). Moreover, we used questionnaires to compare knowledge about exercise (activity requiring physical effort, carried out to improve or improve health and fitness) in MS, usability of the app in general and motivation towards a more active lifestyle after 3 months in both groups. RESULTS The groups showed significant differences in disease duration and PA according to the Godin-Leisure Time Exercise Questionnaire at baseline. After 3 months, we detected no difference in the rate of responders, which was an overall 22%. However, MVPA significantly increased in both groups (p < 0.001) and the intervention group tended to have a higher motivation towards a more active lifestyle (Cohens D = 0.7, p = 0.09) as measured by the questionnaire. Reponses also showed, that participants appreciated the app but claimed a lack of interactivity as a short-coming. CONCLUSION Just providing information in a multimedia smartphone app did not enhance physical activitiy more than a simple leaflet in this small pilot trial in CPMS. However, the group of app users tended to have a higher motivation towards a more active lifestyle. Overall, the concept of a smartphone app to support an active lifestyle in MS is highly appreciated by participants.
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Affiliation(s)
- Navina N. Nasseri
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eghbal Ghezelbash
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Academy for Training and Career, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Yuyang Zhai
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Patra
- Universitäres Kompetenzzentrum für Sport-und Bewegungsmedizin (Athleticum) und Institut und Poliklinik für Medizinische Psychologie, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph 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
| | - Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hopital de la Timone, CEMEREM, APHM, Marseille, France
- CNRS, CRMBM, UMR 7339, Aix Marseille University, Marseille, France
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Colombo C, Confalonieri P, Rovaris M, La Mantia L, Galeazzi P, Silena Trevisan, Pariani A, Gerevini S, De Stefano N, Guglielmino R, Caserta C, Mosconi P, Filippini G. The IN-DEEP project "INtegrating and Deriving Evidence, Experiences, Preferences": a web information model on magnetic resonance imaging for people with multiple sclerosis. J Neurol 2020; 267:2421-2431. [PMID: 32361839 DOI: 10.1007/s00415-020-09864-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The IN-DEEP project aims to provide people with multiple sclerosis (PwMS) with evidence-based information on magnetic resonance imaging (MRI) in diagnosis and monitoring the disease through a website, and to collect their opinions on the clarity of the website's contents and its usefulness. METHODS AND ANALYSIS A multidisciplinary advisory board committee was set up. We investigated the experience, attitude and information needs on MRI through three meetings with 24 PwMS, facilitated by an expert researcher and an observer. We developed the website on the basis of input from PwMS and systematic reviews and guidelines, assessed with AMSTAR and AGREE II. We sought feedback from nine PwMS who pilot-tested the beta-version of the website, during a meeting and through phone interviews and judged whether the contents were clear, understandable and useful, and the website was easily navigable. The website is in Italian. RESULTS The website ( https://www.istituto-besta.it/in-deep-risonanza-magnetica2 ) provides two levels of information, different layouts and visualization of data covering MRI diagnostic accuracy, sensitivity and specificity, contents on how MRI can monitor PwMS over time to determine changes in the condition and evaluate treatment effects, practical information on how to prepare for the exam, educational tools and a glossary. The website was judged clear and useful by a sample of PwMS. CONCLUSIONS The website is a tool to address PwMS information needs on the role of MRI. It could be used by neurologists to facilitate communication with PwMS.
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Affiliation(s)
- Cinzia Colombo
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS, Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Marco Rovaris
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - Loredana La Mantia
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | | | | | | | - Simonetta Gerevini
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Roberta Guglielmino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Cinzia Caserta
- Multiple Sclerosis Center, Policlinico G. Rodolico, University of Catania, Catania, Italy
| | - Paola Mosconi
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Graziella Filippini
- Scientific Direction, Carlo Besta Foundation and Neurological Institute, via Celoria 11, 20133, Milan, Italy
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[Core aspects of a needs-conform care of patients with multiple sclerosis : Utilization of outpatient services and shared decision making]. DER NERVENARZT 2020; 91:503-510. [PMID: 32333050 DOI: 10.1007/s00115-020-00906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Due to the necessity for lifelong treatment, high costs for the healthcare system and changes in role expectations of patients towards physicians, multiple sclerosis (MS) is an important topic in healthcare research. OBJECTIVE The aim of this review is to provide an overview of the current study situation in Germany in 2020 on utilization of outpatient medical resources and shared decision making in patients with MS. MATERIAL AND METHODS For this review a literature search was carried out in PubMed and other extended sources in order to identify and present relevant publications. RESULTS There are only a few studies on the utilization of outpatient medical resources by patients with MS in Germany. The highest values for utilization were found for general practitioners, family physicians and neurologists whereas urologists were less frequently involved. The values for the utilization of services provided by physiotherapists greatly differed between the studies. Several studies using different approaches to shared decision making in Germany were identified and summarized. An important prerequisite for shared decision making is an adequate knowledge on the side of the patients. CONCLUSION Differences in the utilization of outpatient resources by MS patients in Germany can be explained by methodological differences and limitations of the individual studies. The use of shared decision making by MS patients is demanded by various parties but so far there is little evidence for a positive effect on the disease.
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Glanz BI, Zurawski J, Gonzalez CT, Shamah R, Ratajska A, Chitnis T, Weiner HL, Healy BC. Comparison of health-related quality of life across treatment groups in individuals with multiple sclerosis. Mult Scler Relat Disord 2020; 40:101944. [PMID: 32007653 DOI: 10.1016/j.msard.2020.101944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/17/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outcome measures typically used to evaluate disease modifying therapies (DMTs) provide important information regarding their effects on disease activity, but they do not capture the full impact of living with multiple sclerosis (MS). Patient reported outcome measures (PROs) are increasingly being used to capture an individual's subjective experience of disease. We compared DMTs across a wide range of PRO outcomes in individuals with MS. METHODS Subjects enrolled in SysteMS completed the computer adaptive testing version of the Neuro-QoL within four weeks of a clinical neurological exam. Neuro-QoL measures included the following 11 health-related quality of life (HRQOL) domains: Ability to participate in Social Roles and Activities, Anxiety, Cognitive Function, Depression, Emotional and Behavioral Dyscontrol, Fatigue, Lower Extremity Function (mobility), Positive Affect and Wellbeing, Satisfaction with Social Roles and Activities, Stigma, and Upper Extremity Function (fine motor). Treatments were grouped based on the three main modes of delivery: injectable, oral and infusion. The three treatment groups were compared using linear regression adjusting for two sets of covariates (set 1: age, sex, disease duration and EDSS; set 2: age, sex, disease duration, EDSS and treatment duration). We also compared the individual treatments using linear regression. RESULTS After adjusting for the first set of clinical and demographic features of MS, there was a difference between treatment groups for Upper Extremity Function and Stigma. Subjects using injectable treatments reported better functioning in terms of Upper Extremity Function and Stigma than subjects using infusion treatments. In addition, subjects using injectable treatments reported better Upper Extremity Function than subjects treated with oral DMTs. When all individual treatments were compared, interferon-treated subjects reported significantly better functioning in terms of Stigma than natalizumab treated subjects. When further adjusting for time on treatment, the group differences were attenuated and no longer statistically significant. CONCLUSION We examined differences between MS treatment groups across a wide range of HRQOL outcomes. The results suggest that overall there are few differences between treatments on the physical, cognitive and emotional dimensions of well-being.
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Affiliation(s)
- Bonnie I Glanz
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States.
| | - Jonathan Zurawski
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Cindy T Gonzalez
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States
| | - Rebecca Shamah
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States
| | - Adrianna Ratajska
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Howard L Weiner
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Brian C Healy
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States; Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
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Abulaban A, Altowairqi A, Altowairqi H, Almutairi A, Altalhi S, Alotaibi F, Alabbadi I. Multiple Sclerosis Patients Knowledge in Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2019; 24:327-330. [PMID: 31872816 PMCID: PMC8015547 DOI: 10.17712/nsj.2019.4.20190031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: To assess Multiple Sclerosis (MS) patients’ knowledge in Saudi Arabia (SA) and in which aspect of the disease do patient need more awareness. Methods: A cross-sectional web-based survey has been conducted between June and August 2017. It consisted of 2 parts: sociodemographic and 23 multiple choice questions chosen from the previously validated MS Knowledge Questionnaire (MSKQ). The survey has been sent to 500 MS patients. Results: A total of 218 MS patients filled the questionnaire where only 200 included in the study. Female MS patient represents 66% of all the participants. More than half of the patients had achieved their bachelor degree. The total mean of the correct answer for both male and female found to be 58.98%(±SD 15.06%). Most patients were aware that MS is a disease of central nervous system (93%), autoimmune disease (79%), not contagious (90.5%), or inherited (64.5%). However, few patients were aware that there is no single test to diagnose MS (28.5%), and intravenous injection of contrast during MRI reveals new lesions (18.5%). Only (37%) knew what is “Relapsing–remitting”MS. The MS knowledge is positively correlated with the educational level. Conclusion: Patients with MS in SA have less knowledge in the disease’s types, workups, and treatment efficacy. While in contrast, they have more awareness of the disease’s pathophysiology. Patient’s awareness programs should aid more knowledge among MS patients in SA.
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Affiliation(s)
- Ahmad Abulaban
- Division of Neurology, Department of Medicine, King Saud bin-Abdulaziz University for Health Sciences, King Abdulaziz Medical City National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Bužgová R, Kozáková R. Informing patients with progressive neurological disease of their health status, and their adaptation to the disease. BMC Neurol 2019; 19:250. [PMID: 31653233 PMCID: PMC6815047 DOI: 10.1186/s12883-019-1488-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 10/02/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Progressive neurological diseases, such as multiple sclerosis, Parkinson's disease, Huntington's disease, significantly interfere with patients' lives, and those of their families. The aim of the research was to establish whether the extent of the information on patients' health conditions, and the way patients learn this information from doctors affect their adaptation to chronic and progressive diseases. METHODS Qualitative methodology was used for a total of 52 participants (patients with progressive neurological diseases, their family members, and health and social workers). Data were collected using individual, in-depth interviews and focus groups. Analysis of data for interpretation, conceptualization, and re-integration was performed by open, axial, and selective coding. RESULTS It was determined that adequate information about patients' health status, and the use of coping strategies are related to their adaptation to their disease, and consequently, to their quality of life. The participants often considered the extent of the information provided, and the way they were informed to be inadequate. Receiving the diagnosis, the progression of the disease, and the end of life were found to be the most burdensome. CONCLUSION Our results show that Czech neurologist should develop better communication skills, particularly for informing patients with progressive neurological diseases. Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.
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Affiliation(s)
- Radka Bužgová
- Department of Nursing and Midwifery Faculty of Medicine, University of Ostrava, Syllabova 19, 700 30, Ostrava, Czech Republic.
| | - Radka Kozáková
- Department of Nursing and Midwifery Faculty of Medicine, University of Ostrava, Syllabova 19, 700 30, Ostrava, Czech Republic
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Yamaguchi S, Yatsushiro R. Significance and potential of self-management research for HTLV-1 associated myelopathy: review of self-management for people with multiple sclerosis. J Rural Med 2019; 14:7-25. [PMID: 31191762 PMCID: PMC6545424 DOI: 10.2185/jrm.2996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022] Open
Abstract
Objective and Methods: A total of 21 published studies on self-management for people with multiple sclerosis (MS) were reviewed to explore the significance and potential of self-management for people with HTLV-1 associated myelopathy (HAM). These studies were classified based on three concepts: self-management regimen and preferences, context of self-management, and outcomes of self-management. Results: Self-management regimens for people with MS include medical, role, and emotional management. Moreover, self-management regimens are closely associated with the context of self-management, emphasizing the importance of investigating contextual factors and regimens concurrently. Quality of life (QOL) has been evaluated as an outcome of self-management, and self-management has been shown to have both positive and negative effects on the QOL of people with MS. However, insufficient studies focus on self-management regimens and patient preferences; further investigation is necessary to develop effective self-management interventions that reflect the often unique nature of the disease for each individual. The characteristics of HAM are also unique to individual patients. Therefore, investigation of people with HAM in particular is required. Conclusion: This literature review examined the significance of investigating self-management for people with HAM.
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Affiliation(s)
- Saori Yamaguchi
- Department of Fundamental and Clinical Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Rika Yatsushiro
- Department of Fundamental and Clinical Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
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Engels K, Schiffmann I, Weierstall R, Rahn AC, Daubmann A, Pust G, Chard D, Lukas C, Scheiderbauer J, Stellmann J, Heesen C. Emotions towards magnetic resonance imaging in people with multiple sclerosis. Acta Neurol Scand 2019; 139:497-504. [PMID: 30802931 DOI: 10.1111/ane.13082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/21/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES People with multiple sclerosis (pwMS) often have magnetic resonance imaging (MRI) examinations. While MRI can help guide MS management, it may be a source of anxiety for pwMS. We aimed to develop and validate a questionnaire on the "EMotions and Attitudes towards MRI" (MRI-EMA). MATERIAL AND METHODS The questionnaire was developed, tested in two samples of pwMS and validated in a sample of n = 457 pwMS using exploratory (EFA) and confirmatory factor analysis (CFA). RESULTS EFA revealed four factors underlying the questionnaire: fear of MRI scan, fear of MRI results, feeling of control over the disease and feeling of competence in the patient-physician encounter. CFA confirmed the model fit. Receiving the MRI results, but not undergoing the procedure was associated with anxiety. Seeing MRI results gave participants a feeling of control over the disease. Only 50% felt competent to discuss MRI findings with their physician. Fear of MRI results was especially high and feeling of competence low in participants with a short disease duration and little MRI experience. CONCLUSION PwMS do not feel competent when discussing the role, MRI plays in their care. Receiving MRI results caused anxiety and provides some pwMS with a-perhaps false-feeling of control over the disease. The MRI-EMA constitutes a new tool for the assessments of pwMS' feelings towards MRI, that can be applied in future research and clinical settings.
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Affiliation(s)
- Katharina Engels
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
| | | | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Gesa Pust
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation University College London (UCL) Institute of Neurology London UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre London UK
| | - Carsten Lukas
- Department of Neuroradiology, St. Josef‐Hospital Ruhr University Bochum Germany
| | | | - Jan‐Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Hamburg Germany
- Department of Neurology University Medical Centre Hamburg‐Eppendorf (UKE) Hamburg Germany
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Neate SL, Taylor KL, Jelinek GA, De Livera AM, Brown CR, Weiland TJ. Taking active steps: Changes made by partners of people with multiple sclerosis who undertake lifestyle modification. PLoS One 2019; 14:e0212422. [PMID: 30817765 PMCID: PMC6394935 DOI: 10.1371/journal.pone.0212422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background Multiple sclerosis (MS), a demyelinating condition of the central nervous system with an unpredictable course, has a major impact on the lives of people with MS. Partners of people with MS may be significantly affected by the diagnosis, management and uncertainty around disease progression and may provide substantial support and care. Modification of lifestyle risk factors in conjunction with standard medical management has been associated with improved physical and mental quality of life. Adopting major lifestyle modification may have a multi-faceted impact on the person with MS and their partner. Experiences of partners of people with MS have been previously explored, but the experiences of partners of people with MS who adopt this strategy have not. As part of a larger study that aimed to explore partners’ lived experiences of and attitudes towards MS and lifestyle modification, this study reports the active steps and significant changes partners undertook to assist the person with MS and, at times, to also modify their own lives. Design Within an interpretive framework, using Heidegger’s phenomenological philosophy, a qualitative study of semi-structured interviews was conducted. Participants Aged greater than 18 years and in a spousal relationship with a person with MS who had undertaken an intensive residential lifestyle educational intervention promoting healthy lifestyle. Results Themes identified were: adjusting to lifestyle modification, understanding motivations and practical aspects of adjustment; seeking knowledge and support, exploring the ways partners sought positive support for themselves and the person with MS and abandoned negative influences; and embracing well-being, commitment and change, describing the major changes that partners made to their lives professionally and personally. Conclusions The experiences of these partners provide clinicians with insight into potential motivations and outcomes of lifestyle modification and suggest potentially positive aspects for those directly and indirectly affected by MS.
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Affiliation(s)
- Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
- * E-mail:
| | - Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Wilkie DD, Solari A, Nicholas R. Initiating disease-modifying treatments in multiple sclerosis: Measuring the decision process using decisional conflict and decisional regret scales. Mult Scler J Exp Transl Clin 2019; 5:2055217319833006. [PMID: 30834139 PMCID: PMC6393834 DOI: 10.1177/2055217319833006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Initiating disease-modifying treatments (DMTs) in multiple sclerosis (MS) is a major decision for people with (pw)MS but little is known about how the decision is perceived by the individual. Objectives The aim of the study was to determine if decisional conflict (DC) and decisional regret reflect different stages of the decision-making process when initiating DMTs. Methods This was a cross-sectional study of three cohorts of pwMS (n = 254), a 'MS conference attendees', 'on treatment' and an 'offered treatment' cohort. Questionnaires assessing DC, decisional regret and control preference were performed. Results Forty-four per cent (113/254) of pwMS were dissatisfied with their treatment status and 53% (135/254) had DC. DC (p = 0.013) and decisional regret (p = 0.027) increase in treatment-naïve pwMS and also in those 'offered treatment' dissatisfied with their treatment status (p < 0.0001), whilst those 'on treatment' have low Decisional Regret Scale (DRS) score (p = 0.0005). DC and DRS were only correlated with treatment status in those on treatment and not in treatment-naïve patients. F (58/135) pwMS satisfied with treatment had DC. DC (n = 236, adjusted R 2 0.137, p = 0.000) and DRS (n = 235, adjusted R 2 0.232, p = 0.000) were increased by dissatisfaction with treatment, lower potency treatment, being from the 'MS conference attendees' cohort and reliance on the doctor's decision, with DC additionally associated with being employed. Conclusions DC and decisional regret vary in populations at different stages of initiating DMTs and are impacted by non-treatment issues.
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Affiliation(s)
- D D Wilkie
- Imperial College, Centre for Neuroscience, Imperial College Faculty of Medicine, London, UK; Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, UK
| | - A Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - R Nicholas
- Imperial College, Centre for Neuroscience, Imperial College Faculty of Medicine, London, UK; Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, UK.,Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, London, United Kingdom
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Matsen CB, Lyons S, Goodman MS, Biesecker BB, Kaphingst KA. Decision role preferences for return of results from genome sequencing amongst young breast cancer patients. PATIENT EDUCATION AND COUNSELING 2019; 102:155-161. [PMID: 30098907 PMCID: PMC6289762 DOI: 10.1016/j.pec.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To better understand decision role preferences in women diagnosed with breast cancer at a young age for return of results of genome sequencing in research and clinical settings. METHODS Participants were surveyed about communication and decision-making preferences related to genome sequencing results and factors that may affect these preferences. The primary outcome was decision role preference (Control Preference Scale) for selecting what results to receive within medical care or within a research study. RESULTS For results returned as part of medical care, most patients preferred a collaborative (N = 481, 45%) or active (N = 488, 45%) role with only 107 (10%) choosing a passive role. When making the decision as part of a research study, most patients preferred an active role (N = 617, 57%), 350 (33%) choosing a collaborative role, and110 (10%) choosing a passive role. CONCLUSION Most women in this study preferred to share in decision making. Participants had somewhat different role preferences for clinical and research contexts, with greater preference for active roles in the research context. PRACTICE IMPLICATIONS We advocate for practice guidelines that incorporate discussion of decision role as an integral part of patient centered care and shared decision-making and recognize that more work is needed to inform guidelines.
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Affiliation(s)
- Cindy B Matsen
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, 84112, USA; Department of Surgery, University of Utah, Salt Lake City, UT, 84132, USA.
| | - Sarah Lyons
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Department of Biostatistics, College of Global Public Health, New York University, New York, NY, 10003, USA
| | | | - Kimberly A Kaphingst
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, 84112, USA; Department of Communcation, University of Utah, Salt Lake City, UT, 84112, USA
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Rahn AC, Köpke S, Stellmann JP, Schiffmann I, Lukas C, Chard D, Heesen C. Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review. Acta Neurol Scand 2019; 139:18-32. [PMID: 30091223 DOI: 10.1111/ane.13010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
Magnetic resonance imaging (MRI) is the key prognostic tool in people with a clinically isolated syndrome (CIS). There is increasing interest in treating people following a CIS in the hope that conversion to multiple sclerosis (MS) will be prevented and future disability reduced. So far, the prognostic value of MRI for disability following a CIS has not been evaluated systematically. We systematically searched MEDLINE and EMBASE. Cohort studies were selected if they reported associations of MRI and disability following a CIS, included at least 50 people with a CIS at baseline, had at least 5 years of follow-up and obtained at least one structural MRI measurement (T1 lesions, T2 lesions, T1 contrast-enhancing lesions or brain atrophy). We assessed the studies for quality and rated the completeness of MRI reporting. In total, 13 studies were identified reporting on the following: T2 lesion number and volume, T2 infratentorial lesion number and volume, T1 contrast-enhancing lesions and grey matter fraction. T2 brain lesion number determined soon after the occurrence of a CIS was associated with disability progression after 5-7 years, with an increased risk when 10 or more lesions were present. Infratentorial lesions were also associated with a higher risk of subsequent disability. The number and distribution of MRI-visible lesions soon after a CIS are associated with disability later on, and may offer additional useful information when making treatment decisions in people with early MS. Further work is required to determine whether other measures have a higher predictive potential.
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Affiliation(s)
- Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Köpke
- Nursing Research Unit; University of Lübeck; Lübeck Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Carsten Lukas
- Department of Radiology; St. Josef Hospital Bochum; Ruhr University; Bochum Germany
| | - Declan Chard
- NMR Research Unit; Queen Square Multiple Sclerosis Centre; University College London (UCL); Institute of Neurology; London UK
- National Institute for Health Research (NIHR); University College London Hospitals (UCLH); Biomedical Research Centre; London UK
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Neurology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Apolinário-Hagen J, Menzel M, Hennemann S, Salewski C. Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study. JMIR Form Res 2018; 2:e11977. [PMID: 30684408 PMCID: PMC6334710 DOI: 10.2196/11977] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue. Conclusions Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.
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Affiliation(s)
| | - Mireille Menzel
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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Giordano A, Liethmann K, Köpke S, Poettgen J, Rahn AC, Drulovic J, Beckmann Y, Sastre-Garriga J, Galea I, Heerings M, Jongen PJ, Vettorazzi E, Solari A, Heesen C. Risk knowledge of people with relapsing-remitting multiple sclerosis - Results of an international survey. PLoS One 2018; 13:e0208004. [PMID: 30496233 PMCID: PMC6264873 DOI: 10.1371/journal.pone.0208004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/09/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adequate disease and treatment-related risk knowledge of people with Multiple Sclerosis (pwMS) is a prerequisite for informed choices in medical encounters. Previous work showed that MS risk knowledge is low among pwMS and role preferences are different in Italy and Germany. Objective We investigated the level of risk knowledge and role preferences in 8 countries and assessed putative variables associated with risk knowledge. Methods An online-survey was performed based on the Risk knowledge questionnaire for people with relapsing-remitting MS (RIKNO 2.0), the electronic Control Preference Scale (eCPS), and other patient questionnaires. Inclusion criteria of participants were: (1) age ≥18 years, (2) a diagnosis of relapsing-remitting MS (RRMS), (3) being in a decision making process for a disease modifying drug. Results Of 1939 participants from Germany, Italy, the Netherlands, Serbia, Spain and Turkey, 986 (51%) (mean age 38.6 years [range 18–67], 77% women, 7.8 years of disease duration) completed the RIKNO 2.0, with a mean of 41% correct answers. There were less than 50 participants in the UK and Estonia and data were not analysed. Risk knowledge differed across countries (p < 0.001). Variables significantly associated with higher risk knowledge were higher education (p < 0.001), previous experience with disease modifying drugs (p = 0.001), correct answer to a medical data interpretation question (p < 0.001), while higher fear for wheelchair dependency was negatively associated to risk knowledge (p = 0.001). Conclusion MS risk knowledge was overall low and differed across participating countries. These data indicate that information is an unmet need of most pwMS.
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Affiliation(s)
- Andrea Giordano
- Service of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Katrin Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany
- Pediatrics and Medical Psychology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jana Poettgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany
| | - Jelena Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Yesim Beckmann
- Department of Neurology, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Neurology-Neuroimmunology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
| | - Marco Heerings
- National MS Foundation of the Netherlands, Rotterdam, The Netherlands
| | - Peter Joseph Jongen
- Department of Community & Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
- MS4 Research Institute, Nijmegen, The Netherlands
| | - Eik Vettorazzi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Solari
- Service of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Cameron E, Rog D, McDonnell G, Overell J, Pearson O, French DP. Factors influencing multiple sclerosis disease-modifying treatment prescribing decisions in the United Kingdom: A qualitative interview study. Mult Scler Relat Disord 2018; 27:378-382. [PMID: 30500689 DOI: 10.1016/j.msard.2018.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The proportion of people with relapsing-remitting multiple sclerosis prescribed disease modifying treatments (DMTs) in the United Kingdom (UK) is considered low compared with other countries. There are differences in DMT prescription rates between UK nations (England, Wales, Scotland, Northern Ireland). Despite this, there has been little research into decision-making processes and prescribing practices. OBJECTIVE To investigate views and experiences of neurologists prescribing DMTs and MS specialist nurses to identify factors influencing prescribing. METHODS Semi-structured interviews with 18 consultant neurologists and 16 specialist nurses from diverse settings across the four UK nations. Data were analysed using thematic framework analysis. RESULTS Prescribing practices are influenced by organisational prescribing "cultures", informal "benchmarking" within peer networks, and prior experience with different DMTs. Health professionals differ in their perceptions of benefits and risks of DMTs and personal "thresholds" for discerning relapses and determining eligibility for DMTs. Prescribers in England felt most constrained by guidelines. CONCLUSION To achieve equity in access to DMTs for people with MS eligible for treatment, there is a need for public discussion acknowledging differences in health professionals' interpretations of "relapses" and guidelines and perceptions of DMTs, variation in organisational prescribing "cultures", and whether the prevailing culture sufficiently meets patients' needs.
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Affiliation(s)
- Elaine Cameron
- School of Health Sciences, University of Manchester, Manchester, United Kingdom.
| | - David Rog
- Department of Medical Neurosciences (Neurology), Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Gavin McDonnell
- MS Clinic, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - James Overell
- Glasgow MS Clinical Research Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Owen Pearson
- Department of Neurology, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom
| | - David P French
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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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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Reissmann DR, Bellows JC, Kasper J. Patient Preferred and Perceived Control in Dental Care Decision Making. JDR Clin Trans Res 2018; 4:151-159. [PMID: 30931704 DOI: 10.1177/2380084418811321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Shared decision making is increasingly considered the most desirable model for making decisions in medical and dental settings. It supports patients by empowering them to play an active role in the decision-making process. However, dental patients' involvement needs and perceptions have not yet been sufficiently assessed. OBJECTIVES The aim of this study was to assess patients' preferred roles in decision making for a range of dental treatments and whether patients' preferences are being met. METHODS Based on a cross-sectional study design, dental patients' autonomy preferences and actual perceived roles were surveyed in the context of existing dental appointments in a consecutive sample of 101 adult dental patients (aged 20 to 79 y). The questionnaire for the assessment of patient preferred and perceived roles in dental decision making consisted of 14 items, each representing a decision in the broad spectrum of preventive and restorative dental treatment planning, and was administered before the dental appointment and immediately afterward. Responses for each item were indicated on an ordinal 5-point scale, which was adapted from the Control Preference Scale. Differences in overall levels of control and responses for each decision were tested for statistical significance per the Wilcoxon matched-pairs signed-rank test. Furthermore, a multilevel mixed effects linear regression model was computed. RESULTS Patients rated their preferred role in decision making more active and involved than their perceived role. This effect was observed and statistically significant ( P < 0.05) for 11 of 14 treatment decisions. Perceived roles (follow-up) matched the preferred roles (baseline) for less than half of patients. None of the sociodemographic characteristics had a substantial statistical effect on whether perceived roles matched the preferred roles. CONCLUSION Dental patients' perceived roles in decision making do not meet their preferences. Dentists should allow and encourage their patients to be more active in decision making. KNOWLEDGE TRANSFER STATEMENT Since dental patients' perceived roles in decision making do not meet their preferences, clinicians should encourage and enable their dental patients to fulfill the role in decision making that they prefer. This may help in the future to not only fulfill the right of patients to be informed but also empower them to play an active role in the decision-making process and reduce the risk of decisional conflicts.
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Affiliation(s)
- D R Reissmann
- 1 Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J C Bellows
- 1 Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Kasper
- 2 Division of Internal Medicine, University Hospital of Northern Norway, Tromsø, Norway.,3 Department of Health and Caring Sciences, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
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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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Day GS, Rae-Grant A, Armstrong MJ, Pringsheim T, Cofield SS, Marrie RA. Identifying priority outcomes that influence selection of disease-modifying therapies in MS. Neurol Clin Pract 2018; 8:179-185. [PMID: 30105155 DOI: 10.1212/cpj.0000000000000449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
Abstract
Background Persons with multiple sclerosis (MS) may now choose from a broad array of approved disease-modifying treatments (DMTs). The priority that patients and practitioners assign to specific clinical outcomes is likely to influence the MS DMT selection process. Methods We invited 9,126 participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry and 18 members of the American Academy of Neurology MS DMT guideline development panel to complete a brief survey prioritizing outcomes of importance to MS DMT selection. The frequency of outcomes ranked as first, second, or third priority by respondents were compared across groups. Results A total of 2,056 of 9,126 (23.6%) NARCOMS participants and all 18 members of the MS DMT guideline development panel (100%) completed the survey. Reduced disability progression was identified as a priority by a majority of respondents in both groups. Guideline panelists tended to be more likely than persons with MS to prioritize relapse rate reduction (p = 0.055). Respondents from both groups commonly cited the "selection of therapies most likely to lead to improvements in quality of life measures, MS symptoms, and preservation of cognition" as top priorities in DMT selection; however, these priority outcomes were reported in fewer than 20% of clinical trials used to inform MS DMT guideline development. Conclusion Specific outcomes were defined by similar proportions of persons with MS and guideline panelists as priority outcomes influencing MS DMT selection. Several of these priority outcomes were not routinely reported in clinical trials, identifying areas for future evidence development.
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Affiliation(s)
- Gregory S Day
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Alexander Rae-Grant
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Melissa J Armstrong
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Tamara Pringsheim
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Stacey S Cofield
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- The Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology (GSD), Washington University School of Medicine, St. Louis, MO; Department of Neurology (AR-G), Cleveland Clinic, OH; Department of Neurology (MJA), University of Florida College of Medicine, Gainesville; Departments of Community Health Sciences and Clinical Neurosciences and Hotchkiss Brain Institute and O'Brien Institute for Public Health (TP), University of Calgary, Canada; Department of Biostatistics (SSC), University of Alabama Birmingham; and Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
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Rahn A, Köpke S, Backhus I, Kasper J, Anger K, Untiedt B, Alegiani A, Kleiter I, Mühlhauser I, Heesen C. Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation. Int J Nurs Stud 2018; 78:26-36. [DOI: 10.1016/j.ijnurstu.2017.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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Gaissmaier W, Giese H, Galesic M, Garcia-Retamero R, Kasper J, Kleiter I, Meuth SG, Köpke S, Heesen C. Numeracy of multiple sclerosis patients: A comparison of patients from the PERCEPT study to a German probabilistic sample. PATIENT EDUCATION AND COUNSELING 2018; 101:74-78. [PMID: 28764895 DOI: 10.1016/j.pec.2017.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/05/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A shared decision-making approach is suggested for multiple sclerosis (MS) patients. To properly evaluate benefits and risks of different treatment options accordingly, MS patients require sufficient numeracy - the ability to understand quantitative information. It is unknown whether MS affects numeracy. Therefore, we investigated whether patients' numeracy was impaired compared to a probabilistic national sample. METHODS As part of the larger prospective, observational, multicenter study PERCEPT, we assessed numeracy for a clinical study sample of German MS patients (N=725) with a standard test and compared them to a German probabilistic sample (N=1001), controlling for age, sex, and education. Within patients, we assessed whether disease variables (disease duration, disability, annual relapse rate, cognitive impairment) predicted numeracy beyond these demographics. RESULTS MS patients showed a comparable level of numeracy as the probabilistic national sample (68.9% vs. 68.5% correct answers, P=0.831). In both samples, numeracy was higher for men and the highly educated. Disease variables did not predict numeracy beyond demographics within patients, and predictability was generally low. CONCLUSION This sample of MS patients understood quantitative information on the same level as the general population. PRACTICE IMPLICATIONS There is no reason to withhold quantitative information from MS patients.
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Affiliation(s)
- Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Konstanz, Germany; Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany.
| | - Helge Giese
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | | | - Juergen Kasper
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Münster, Germany
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Clinical MS Research and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cofield SS, Thomas N, Tyry T, Fox RJ, Salter A. Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry. Int J MS Care 2017; 19:303-312. [PMID: 29270088 DOI: 10.7224/1537-2073.2016-091] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.
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Heesen C, Pöttgen J, Rahn AC, Liethmann K, Kasper J, Vahter L, Drulovic J, Van Nunen A, Wilkie D, Beckmann Y, Paul F, Köpke S, Giordano A, Solari A. What should a person with relapsing-remitting multiple sclerosis know? - Focus group and survey data of a risk knowledge questionnaire (RIKNO 2.0). Mult Scler Relat Disord 2017; 18:186-195. [PMID: 29141808 DOI: 10.1016/j.msard.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk knowledge is relevant to make informed decisions in multiple sclerosis (MS). The risk knowledge questionnaire for relapsing-remitting MS (RIKNO 1.0) was developed and piloted in Germany. OBJECTIVE To produce a revised RIKNO 2.0 questionnaire using mixed methodology in a European setting. METHODS The questionnaire was translated in seven languages. MS patient and health professional (HP) expert feedback was obtained from Germany, Italy, Estonia, Serbia, and the UK. A German web-based survey of RIKNO 2.0 compared the tool with the MS Knowledge Questionnaire (MSKQ), each one used with two versions (with/without a "don't know" DN option). RESULTS While RIKNO 2.0 was considered difficult, it was rated as highly educational. One item was reframed, and two new items were added. The web-based German survey (n = 708 completers) showed that the DN version did not increase participation rate and did not produce significantly higher scores. Internal consistency (Cronbach alpha) without SN response was 0.73. RIKNO 2.0 scores showed normality distribution irrespective of the answering format. Item difficulty was high ranging from 0.07 to 0.79. Less than 50% of questions were answered correctly (mean 8.9) compared to 80.4% in the MSKQ (mean 20.1). Higher numeracy competency and education were significantly, albeit weakly, associated to higher scores for both RIKNO 2.0 and MSKQ. CONCLUSION Including "don't know" options in knowledge questionnaires does not increase percentage of correct replies. RIKNO 2.0 is a complex questionnaire to be used in an educational context and studies on patient information. The tool is now available in seven languages.
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Affiliation(s)
- C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Neurologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - A C Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - K Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - J Kasper
- Faculty of Health Sciences, Arctic University of Norway, 9073 Tromsø, Norway.
| | - L Vahter
- Department of Neurology, West-Tallinn Central Hospital, Paldiski mnt. 68, 10617 Tallinn, Estonia.
| | - J Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Dr. Subotića Starijeg 6, 11000 Beograd, Serbia.
| | - A Van Nunen
- National MS-Centrum, Melsbroek, Vereeckenstraat 44, 1820 Melsbroek, Belgium.
| | - D Wilkie
- Clinical Trials Unit, Department of Neurology, Imperial College, Room 10L18 (Lab Block, Charing Cross Campus, Hammersmith, London W6 8RF, UK.
| | - Y Beckmann
- Department of Neurology, Ataturk Training and Research Hospital, Faculty of Medicine, Konak Mahallesi, İnönü Cad. 269. Sok. No:102, 35150 Karabağlar, Izmir, Turkey.
| | - F Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - S Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
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