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De Brouwer E, Becker T, Werthen-Brabants L, Dewulf P, Iliadis D, Dekeyser C, Laureys G, Van Wijmeersch B, Popescu V, Dhaene T, Deschrijver D, Waegeman W, De Baets B, Stock M, Horakova D, Patti F, Izquierdo G, Eichau S, Girard M, Prat A, Lugaresi A, Grammond P, Kalincik T, Alroughani R, Grand’Maison F, Skibina O, Terzi M, Lechner-Scott J, Gerlach O, Khoury SJ, Cartechini E, Van Pesch V, Sà MJ, Weinstock-Guttman B, Blanco Y, Ampapa R, Spitaleri D, Solaro C, Maimone D, Soysal A, Iuliano G, Gouider R, Castillo-Triviño T, Sánchez-Menoyo JL, Laureys G, van der Walt A, Oh J, Aguera-Morales E, Altintas A, Al-Asmi A, de Gans K, Fragoso Y, Csepany T, Hodgkinson S, Deri N, Al-Harbi T, Taylor B, Gray O, Lalive P, Rozsa C, McGuigan C, Kermode A, Sempere AP, Mihaela S, Simo M, Hardy T, Decoo D, Hughes S, Grigoriadis N, Sas A, Vella N, Moreau Y, Peeters L. Machine-learning-based prediction of disability progression in multiple sclerosis: An observational, international, multi-center study. PLOS DIGITAL HEALTH 2024; 3:e0000533. [PMID: 39052668 PMCID: PMC11271865 DOI: 10.1371/journal.pdig.0000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Disability progression is a key milestone in the disease evolution of people with multiple sclerosis (PwMS). Prediction models of the probability of disability progression have not yet reached the level of trust needed to be adopted in the clinic. A common benchmark to assess model development in multiple sclerosis is also currently lacking. METHODS Data of adult PwMS with a follow-up of at least three years from 146 MS centers, spread over 40 countries and collected by the MSBase consortium was used. With basic inclusion criteria for quality requirements, it represents a total of 15, 240 PwMS. External validation was performed and repeated five times to assess the significance of the results. Transparent Reporting for Individual Prognosis Or Diagnosis (TRIPOD) guidelines were followed. Confirmed disability progression after two years was predicted, with a confirmation window of six months. Only routinely collected variables were used such as the expanded disability status scale, treatment, relapse information, and MS course. To learn the probability of disability progression, state-of-the-art machine learning models were investigated. The discrimination performance of the models is evaluated with the area under the receiver operator curve (ROC-AUC) and under the precision recall curve (AUC-PR), and their calibration via the Brier score and the expected calibration error. All our preprocessing and model code are available at https://gitlab.com/edebrouwer/ms_benchmark, making this task an ideal benchmark for predicting disability progression in MS. FINDINGS Machine learning models achieved a ROC-AUC of 0⋅71 ± 0⋅01, an AUC-PR of 0⋅26 ± 0⋅02, a Brier score of 0⋅1 ± 0⋅01 and an expected calibration error of 0⋅07 ± 0⋅04. The history of disability progression was identified as being more predictive for future disability progression than the treatment or relapses history. CONCLUSIONS Good discrimination and calibration performance on an external validation set is achieved, using only routinely collected variables. This suggests machine-learning models can reliably inform clinicians about the future occurrence of progression and are mature for a clinical impact study.
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Affiliation(s)
| | - Thijs Becker
- I-Biostat, Hasselt University, Belgium
- Data Science Institute, Hasselt University, Belgium
| | | | - Pieter Dewulf
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
| | - Dimitrios Iliadis
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
| | - Cathérine Dekeyser
- Department of Neurology, Ghent University, Belgium
- 4 Brain, Ghent University, Belgium
- Biomedical Research Institute, Hasselt University, Belgium
| | - Guy Laureys
- Department of Neurology, Ghent University, Belgium
- 4 Brain, Ghent University, Belgium
| | - Bart Van Wijmeersch
- Noorderhart ziekenhuizen Pelt, Belgium
- Universitair MS Centrum Hasselt-Pelt, Belgium
| | - Veronica Popescu
- Noorderhart ziekenhuizen Pelt, Belgium
- Universitair MS Centrum Hasselt-Pelt, Belgium
| | - Tom Dhaene
- SUMO, IDLAB, Ghent University - imec, Belgium
| | | | - Willem Waegeman
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
| | - Bernard De Baets
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
| | - Michiel Stock
- KERMIT, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
- Biobix, Department of Data Analysis and Mathematical Modelling, Ghent University, Belgium
| | - Dana Horakova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marc Girard
- CHUM and Université de Montreal, Montreal, Canada
| | | | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia and Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | | | - Tomas Kalincik
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | - Oliver Gerlach
- Academic MS Center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Samia J. Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Maria José Sà
- Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | | | | | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Claudio Solaro
- Dept. of Rehabilitation, CRFF Mons. Luigi Novarese, Moncrivello, Italy
| | - Davide Maimone
- MS center, UOC Neurologia, ARNAS Garibaldi, Catania, Italy
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | | | | | | | | | | | - Jiwon Oh
- St. Michael’s Hospital, Toronto, Canada
| | | | - Ayse Altintas
- Koc University, School of Medicine, Istanbul, Turkey
| | - Abdullah Al-Asmi
- College of Medicine & Health Sciences and Sultan Qaboos University Hospital, SQU, Oman
| | | | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | | | - Norma Deri
- Hospital Fernandez, Capital Federal, Argentina
| | - Talal Al-Harbi
- King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia
| | | | - Orla Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | | | - Allan Kermode
- University of Western Australia, Nedlands, Australia
| | | | - Simu Mihaela
- Emergency Clinical County Hospital Pius Brinzeu, Timisoara, Romania and University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | | | - Todd Hardy
- Concord Repatriation General Hospital, Sydney, Australia
| | - Danny Decoo
- AZ Alma Ziekenhuis, Sijsele - Damme, Belgium
| | | | | | | | | | | | - Liesbet Peeters
- Data Science Institute, Hasselt University, Belgium
- Universitair MS Centrum Hasselt-Pelt, Belgium
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2
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Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis. Mult Scler Relat Disord 2022; 68:104138. [PMID: 36029707 DOI: 10.1016/j.msard.2022.104138] [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: 04/08/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. METHODS We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. RESULTS Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. CONCLUSION Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.
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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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Diakou I, Papakonstantinou E, Papageorgiou L, Pierouli K, Dragoumani K, Spandidos DA, Bacopoulou F, Chrousos GP, Goulielmos GΝ, Eliopoulos E, Vlachakis D. Multiple sclerosis and computational biology (Review). Biomed Rep 2022; 17:96. [PMID: 36382258 PMCID: PMC9634047 DOI: 10.3892/br.2022.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease whose prevalence has increased worldwide. The resultant symptoms may be debilitating and can substantially reduce the of patients. Computational biology, which involves the use of computational tools to answer biomedical questions, may provide the basis for novel healthcare approaches in the context of MS. The rapid accumulation of health data, and the ever-increasing computational power and evolving technology have helped to modernize and refine MS research. From the discovery of novel biomarkers to the optimization of treatment and a number of quality-of-life enhancements for patients, computational biology methods and tools are shaping the field of MS diagnosis, management and treatment. The final goal in such a complex disease would be personalized medicine, i.e., providing healthcare services that are tailored to the individual patient, in accordance to the particular biology of their disease and the environmental factors to which they are subjected. The present review article summarizes the current knowledge on MS, modern computational biology and the impact of modern computational approaches of MS.
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Affiliation(s)
- Io Diakou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Eleni Papakonstantinou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Louis Papageorgiou
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Katerina Pierouli
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Konstantina Dragoumani
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
| | - Georges Ν. Goulielmos
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Elias Eliopoulos
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of The Academy of Athens, 11527 Athens, Greece
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5
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Long-term prognosis communication preferences in early-stage relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 64:103969. [PMID: 35728432 DOI: 10.1016/j.msard.2022.103969] [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: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their future lives. Improving communication strategies on prognosis may help patients deal with the disease and adjust their long-term life goals. However, there is limited information on patients' preferences of long-term prognosis (LTP) communication and associated factors. OBJECTIVE The aim of this study was to describe patients' preferences and assess the factors associated with LTP communication preferences in early-stage relapsing-remitting multiple sclerosis (RRMS) patients. METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration from first attack ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The Prognosis in MS questionnaire was used to assess how much patients want to know about their LTP. Different patient-reported measures were administered to gather information on symptom severity, pain, fatigue, mood/anxiety, quality of life, stigma, illness perception, feeling of hopelessness, self-efficacy, information avoidance and coping strategies. Cognition was assessed using the Symbol Digit Modalities Test (SDMT). A multivariate logistic regression analysis was performed to assess the association between LTP information preference and demographic and clinical characteristics, as well as patients' perspectives. RESULTS A total of 189 patients were included (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.2 ± 0.8 years). Median EDSS score was 1.0 (IQR = 0.0-2.0). A proportion of 68.5% (n = 126) of patients had never discussed LTP with their neurologists, whereas 69.2% (n = 126) reported interest in knowing it (73.5% at diagnosis). Bivariate analyses suggested that patients were significantly more likely to have higher LTP information preferences if they were male and had a lower SDMT score. Male gender and a lower SDMT score were predictors of LTP information preferences. CONCLUSIONS Patients with early-stage RRMS want to discuss their LTP shortly after diagnosis. Understanding the factors involved may be useful to design individualized communication strategies.
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6
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Motor evoked potentials for multiple sclerosis, a multiyear follow-up dataset. Sci Data 2022; 9:207. [PMID: 35577808 PMCID: PMC9110383 DOI: 10.1038/s41597-022-01335-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic disease affecting millions of people worldwide. Through the demyelinating and axonal pathology of MS, the signal conduction in the central nervous system is affected. Evoked potential measurements allow clinicians to monitor this process and can be used for decision support. We share a dataset that contains motor evoked potential (MEP) measurements, in which the brain is stimulated and the resulting signal is measured in the hands and feet. This results in time series of 100 milliseconds long. Typically, both hands and feet are measured in one hospital visit. The dataset contains 5586 visits of 963 patients, performed in day-to-day clinical care over a period of 6 years. The dataset consists of approximately 100,000 MEP. Clinical metadata such as the expanded disability status scale, sex, and age is also available. This dataset can be used to explore the role of evoked potentials in MS research and patient care. It may also be used as a benchmark for time series analysis and predictive modelling. Measurement(s) | Abnormal upper-limb motor evoked potentials • Abnormal lower-limb motor evoked potentials • Kurtzke Expanded Disability Status Scale Clinical Classification | Technology Type(s) | Transcranial Magnetic Stimulation • performing a clinical assessment | Factor Type(s) | Date of birth • Sex • Measurement date | Sample Characteristic - Organism | Homo sapiens | Sample Characteristic - Location | Belgium |
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: Perspectives of people with aphasia on receiving information about recovery. Neuropsychol Rehabil 2022; 33:871-902. [PMID: 35297737 DOI: 10.1080/09602011.2022.2051565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many people with aphasia (language impairment post-stroke) want to know their prognosis for recovery, yet current understanding of their experience of receiving prognoses is limited. Such insight is necessary to inform clinical practice in formulating and delivering aphasia prognoses, especially given the psycho-emotional distress and secondary adverse effects on recovery associated with conversations about prognosis. We sought an in-depth understanding of the perspectives of people with aphasia in relation to receiving prognoses post-stroke, with the aim of informing an evidence-based approach to aphasia prognostication in clinical practice. Semi-structured interviews, facilitated by communication support strategies, were conducted one-to-one with eight people with aphasia (ranging from mild to very severe) 3-12 months post-stroke. Reflexive thematic analysis was used to analyse the qualitative data, yielding two over-arching themes: (1) How would you know without knowing me?; (2) I need to know, but I don't want to know. Our findings illustrate issues of mistrust within the patient-clinician relationship, and complex emotions relating to hope and post-stroke adjustment. The present insight into the lived experience of receiving aphasia prognoses highlights the need for focused consideration of personal definitions of normalcy, measures for fostering trust, and the role of prognostic uncertainty.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
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8
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Alifirova V, Kamenskikh E, Koroleva E, Kolokolova E, Petrakovich A. Prognostic markers of multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:22-27. [DOI: 10.17116/jnevro202212202122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Vincent C, Wegier P, Chien V, Kurahashi AM, Ginsburg S, Molla Ghanbari H, Wolfstadt JI, Cram P. Qualitative Evaluation of a Novel Educational Tool to Communicate Individualized Hip Fracture Prognostic Information to Patients and Surrogates: My Hip Fracture (My-HF). Geriatr Orthop Surg Rehabil 2021; 12:21514593211050513. [PMID: 34707914 PMCID: PMC8543715 DOI: 10.1177/21514593211050513] [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: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Mortality and morbidity are high for older adults after hip fracture (HF), but patients and surrogate decision makers (SDMs) are typically unaware of the poor prognosis. We developed a novel educational tool, My Hip Fracture (My-HF), to provide patients and SDMs of patients hospitalized with acute HF individualized estimates of their post-HF prognosis. We conducted initial usability testing of My-HF in a sample of patients with HF and SDMs. MATERIALS AND METHODS My-HF provides information about: 1) anatomy and risk factors for HF; 2) Hip fracture treatment received; 3) individualized predicted risk of adverse events and 4) anticipated discharge trajectory. We conducted a qualitative usability study using a convenience sample of hospitalized, post-operative patients with acute HF or SDMs of patients who lacked decision-making capacity. We used semi-structured interviews to obtain feedback. Thematic analysis was used to identify themes and concepts. RESULTS We conducted interviews with 8 patients and 9 SDMs (mean age of interviewees 70.1 years, 41% female). My-HF was generally well received. Thematic analysis identified legibility and visual appeal, comprehension, numeracy, utility and reflection as prominent themes. Most respondents found My-HF to be useful in improving their understanding of HF and as a potential mechanism for sharing information with other care team members (including family and professionals). Suggestions for improvement of legibility, presentation of the individualized prognosis information and content were identified. DISCUSSION Patients and SDMs are generally accepting of My-HF and found it useful for communicating individualized prognostic information. Feedback identified areas for improvement for future iterations of the tool. CONCLUSION My-HF presents a means of addressing the gap in understanding of prognosis post-HF as a part of patient-centered care. Further evaluation will be needed to assess the impact of My-HF on patient and SDM reported outcomes as we transition from a paper to smart-phone enabled web application.
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Affiliation(s)
- Corita Vincent
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pete Wegier
- Temmy Latner Centre for Palliative
Care, Sinai Health System, Toronto, ON, Canada
| | - Vincent Chien
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal
Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
| | | | - Shiphra Ginsburg
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal
Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
| | - Hedieh Molla Ghanbari
- Department of Family and Community
Medicine, University of Toronto, Toronto, ON, Canada
| | - Jesse Isaac Wolfstadt
- Granovsky Gluskin Division of
Orthopaedic Surgery, Sinai Health System, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal
Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
- Institute for Health Policy,
Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of General Internal
Medicine and Geriatrics, University Health Network, Toronto, ON, Canada
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10
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Maguire R, McKeague B, Kóka N, Coffey L, Maguire P, Desmond D. The role of expectations and future-oriented cognitions in quality of life of people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 56:103293. [PMID: 34624641 DOI: 10.1016/j.msard.2021.103293] [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: 08/31/2020] [Revised: 03/10/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Multiple Sclerosis (MS) is a highly variable condition characterised by uncertainty of disease course which can make formation of expectations about the future difficult. This systematic review aimed to examine associations between expectations, or Future Oriented Cognitions (FOCs), and Quality of Life (QOL) in people with MS (PwMS). METHODS Following PRISMA guidelines, literature up to October 2019 was searched using Medline, EMBASE, PsycINFO and Web of Science. Quantitative studies that investigated relationships between FOCs and QOL in PwMS (assessed using a standardised QOL assessment) were considered for inclusion. After data extraction, results were analysed using narrative synthesis, focusing on the valence of FOCs (positive, negative, unvalenced). Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). All stages of the review were patient-led by a person with MS. RESULTS A total of 13 studies met the review inclusion criteria, with a combined sample size of 4,179. Of these studies, 11 involved measures of positive FOCs, most commonly self-efficacy, one measured a negative FOC, with one FOC unclassified. Nine studies found significant associations between QOL and self-efficacy. Although other positively valenced constructs were less frequently reported, significant associations with higher QOL were also evidenced. CONCLUSIONS Identifying ways to foster positive FOCs, particularly self-efficacy, may have beneficial effects on QOL. More research is needed to understand the impacts of negative FOCs on QOL to determine whether these processes could be meaningfully targeted in interventions.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University.
| | | | | | - Laura Coffey
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University
| | - Phil Maguire
- Department of Computer Science, Maynooth University
| | - Deirdre Desmond
- Department of Psychology, Maynooth University; Assisting Living and Learning Institute, Maynooth University
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Caulfield A, Plymoth A, Nartey YA, Mölsted-Alvesson H. The 6-star doctor? Physicians' communication of poor prognosis to patients and their families in Cape Coast, Ghana. BMJ Glob Health 2021; 5:bmjgh-2020-002334. [PMID: 32565427 PMCID: PMC7311005 DOI: 10.1136/bmjgh-2020-002334] [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: 01/24/2020] [Revised: 04/03/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Communication is considered a key skill for physicians globally and has formed a central part of medical curricula since the WHO identified it as a key attribute of the '5-star doctor'. Communication of poor prognosis to patients and caregivers is particularly challenging, yet an important example of physicians' clinical communication, and a priority within palliative care research. Knowledge is scarce regarding the different positions physicians adopt during poor prognosis communication, especially in sub-Saharan countries. METHODS This qualitative study took place at the Cape Coast Teaching Hospital in Ghana's Central Region. Physicians in the internal medicine department, with experience in communicating poor prognosis to patients and families on a weekly basis were purposively sampled. Based on the concept of information power, a maximum variation of participants, in terms of age, sex, seniority and experience was achieved after conducting 10 semistructured interviews in March 2019. Positioning theory was used as a theoretical lens to inform study design. The data were analysed through a constructivist thematic analysis approach. RESULTS Physicians adopted six positions, considered as six different themes, during their communication of poor prognosis: clinical expert, educator, counsellor, communicator, protector and mentor. Physicians' choice of position was fluid, guided by local context and wider health system factors. Physicians' desire to communicate with patients and families in a way that met their needs highlighted three key challenges for communication of poor prognosis: linguistic difficulties, pluralistic health beliefs and the role of family. These challenges presented ethical complexities in relation to autonomy and non-maleficence. CONCLUSION Context is key to physicians' communication of poor prognosis. Communication of poor prognosis is multifaceted, complex and unpredictable. Physicians' communication training should be developed to emphasise contextual circumstances and physician support, and international policy models on physicians' roles developed to include a greater focus on social accountability.
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Affiliation(s)
- Alexandra Caulfield
- Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Yvonne Ayerki Nartey
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Helle Mölsted-Alvesson
- Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
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12
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Lewis ET, Hammill KA, Ticehurst M, Turner RM, Greenaway S, Hillman K, Carlini J, Cardona M. How Do Patients with Life-Limiting Illness and Caregivers Want End-Of-Life Prognostic Information Delivered? A Pilot Study. Healthcare (Basel) 2021; 9:healthcare9070784. [PMID: 34206435 PMCID: PMC8303293 DOI: 10.3390/healthcare9070784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to identify the level of prognostic disclosure, type of prognostic information and delivery format of prognostic communication that older adults diagnosed with a life-limiting illness or caregivers prefer to receive. We developed and pilot tested an open-ended survey to 15 older patients and caregivers who had experience in health services for life-limiting illness either for a relative, friend or themselves. Five hypothetical clinical scenarios of prognostic options were presented to ascertain preferences. The preferred format to receive prognostic information was verbal delivery by the clinician with a written summary. Photos and videos were less favoured, and a table with numbers/percentages was least preferred. Distress levels to the prognostic scenarios were low, with the exception of a photo. We conclude that older patients/caregivers want end-of-life prognostic information delivered the traditional way, verbally by clinicians. Options to deliver prognostic information may vary across patient groups but empower clinicians in introducing end-of-life discussions with patients/caregivers. Our study illustrates the feasibility of involving terminal patients and caregivers in research that contributes to eliciting prognostic preferences. Further research is needed to understand whether the prognostic preferences of hospitalized patients with life-limiting illness differ.
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Affiliation(s)
- Ebony T. Lewis
- School of Population Health, The University of New South Wales, Sydney 2052, Australia
- School of Psychology, The University of New South Wales, Sydney 2052, Australia
- Correspondence:
| | - Kathrine A. Hammill
- School of Science and Health, Western Sydney University, Campbelltown 2560, Australia;
| | - Maree Ticehurst
- South Western Sydney Clinical School, University of New South Wales, Liverpool 2170, Australia; (M.T.); (K.H.)
| | - Robin M. Turner
- Biostatistics Unit, Otago Medical School, University of Otago, Dunedin 9054, New Zealand;
| | - Sally Greenaway
- Supportive and Palliative Medicine, Westmead Hospital, Westmead 2145, Australia;
| | - Ken Hillman
- South Western Sydney Clinical School, University of New South Wales, Liverpool 2170, Australia; (M.T.); (K.H.)
- Intensive Care Unit, Liverpool Hospital, Liverpool 2170, Australia
| | - Joan Carlini
- Department of Marketing, Griffith University, Southport 4222, Australia;
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Robina 4226, Australia;
- EBP Professorial Unit, Gold Coast University Hospital, Southport 4215, Australia
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Rahn AC, Solari A, Beckerman H, Nicholas R, Wilkie D, Heesen C, Giordano A. "I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis. Int J MS Care 2021; 22:285-293. [PMID: 33424485 DOI: 10.7224/1537-2073.2020-027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice. Methods We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form. Results From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge. Conclusions The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.
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Celius EG, Thompson H, Pontaga M, Langdon D, Laroni A, Potra S, Bharadia T, Yeandle D, Shanahan J, van Galen P, Alexandri N, Kesselring J. Disease Progression in Multiple Sclerosis: A Literature Review Exploring Patient Perspectives. Patient Prefer Adherence 2021; 15:15-27. [PMID: 33447018 PMCID: PMC7802794 DOI: 10.2147/ppa.s268829] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients' understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL). METHODS Literature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted. RESULTS Little qualitative evidence exists that examines PwMS' perspectives on MS progression. The understanding and meaning ascribed to terms such as "disease progression" vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme. CONCLUSION Patient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.
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Affiliation(s)
- Elisabeth G Celius
- Deparment of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Correspondence: Elisabeth G Celius Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo0424, NorwayTel +47 91 50 27 70 Email
| | - Heidi Thompson
- The Neurology Centre, Craigavon Area Hospital, Portadown, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stanca Potra
- Patient Member of the MS in the 21st Century Steering Group, Bucharest, Romania
| | - Trishna Bharadia
- Patient Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - David Yeandle
- Patient Member of the MS in the 21st Century Steering Group, Southampton, UK
| | - Jane Shanahan
- Patient Member of the MS in the 21st Century Steering Group, Ascot, UK
| | - Pieter van Galen
- Patient Member of the MS in the 21st Century Steering Group, Overijse, Belgium
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Kliniken Valens, Valens, Switzerland
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15
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Kosch R, Schiffmann I, Daumer M, Lederer C, Scalfari A, Galea I, Scheiderbauer J, Rahn A, Heesen C. Long-term prognostic counselling in people with multiple sclerosis using an online analytical processing tool. Mult Scler 2020; 27:1442-1450. [PMID: 33103987 DOI: 10.1177/1352458520964774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prognostic counselling is a sensitive issue in medicine and especially so in MS due to the highly heterogeneous disease course. However, people with MS (pwMS) seek prognostic information. The web-based 'Evidence-Based Decision Support Tool in Multiple Sclerosis' (EBDiMS) uses data of 717 patients from the London/Ontario cohort to calculate personalized long-term prognostic information. OBJECTIVE The aim of this study was to investigate the feasibility and effect of long-term prognostic counselling in pwMS using EBDiMS. METHODS Ninety consecutive pwMS were provided with personalized estimations of expected time to reach Expanded Disability Status Scale (EDSS) scores of 6 and 8 and time to conversion to secondary-progressive MS. Participants gave estimates on their own putative prognosis and rated the tool's acceptability on six-step Likert-type scales. RESULTS Participants rated EBDiMS as highly understandable, interesting and relevant for patient-physician encounters, coping and therapy decisions. Although it provoked a certain degree of worry in some participants, 95% would recommend using the tool. Participants' own prognosis estimates did not change significantly following EBDiMS. CONCLUSION Long-term prognostic counselling using an online tool has been shown to be feasible in a clinical setting. EBDiMS provides pwMS with relevant, easy-to-understand, long-term prognostic information without causing relevant anxiety.
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Affiliation(s)
- Ricardo Kosch
- 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/Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Daumer
- Sylvia Lawry Center for Multiple Sclerosis Research & Human Motion Institute, Munich, Germany
| | - Christian Lederer
- Sylvia Lawry Center for Multiple Sclerosis Research & Human Motion Institute, Munich, Germany
| | - Antonio Scalfari
- Division of Neuroinflammation and Neurodegeneration, Department of Medicine, Imperial College London, London, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jutta Scheiderbauer
- Stiftung für Selbstbestimmung und Selbstvertretung von MS-Betroffenen, Trier, Germany
| | - Anne Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - 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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Saposnik G, Sotoca J, Sempere ÁP, Candeliere-Merlicco A, Díaz-Abós P, Tobler PN, Terzaghi M, Maurino J. Therapeutic status quo in patients with relapsing-remitting multiple sclerosis: A sign of poor self-perception of their clinical status? Mult Scler Relat Disord 2020; 45:102354. [DOI: 10.1016/j.msard.2020.102354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
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AlJumah M, Alkhawajah MM, Qureshi S, Al-Thubaiti I, Ayoub O, Bohlega SA, Bushnag A, Cupler E, Daif A, El Boghdady A, Hassan A, Al Malik Y, Saeedi J, Al-Shamrany F, Shosha E, Rieckmann P. Cladribine Tablets and Relapsing-Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know. Neurol Ther 2020; 9:11-23. [PMID: 32056129 PMCID: PMC7229040 DOI: 10.1007/s40120-020-00177-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
Immune reconstitution therapy (IRT) is an emerging management concept for multiple sclerosis, whereby a short course of treatment provides long-lasting suppression of disease activity. "Cladribine tablets 10 mg" refers to a total cumulative dose of cladribine given over 2 years (henceforth referred to as cladribine tablets 3.5 mg/kg); it is a relatively new treatment option that is hypothesised to act as an IRT acting preferentially on the adaptive immune system. A randomised, 2-year, placebo-controlled trial (CLARITY) showed that treatment with cladribine tablets reduced indices of disease activity (relapses, lesions on magnetic resonance images, disability progression) and that this effect outlasted the pharmacologic effect of the treatment on the immune system (mainly a reduction in circulating B and T cells, with little effect on components of the innate immune system such as monocytes). CLARITY Extension, a 2-year extension to this trial, demonstrated durable efficacy, also in patients who received the standard 2-year course of cladribine tablets 3.5 mg/kg and were re-randomised to placebo for a further 2 years. Relative risk reductions for relapse rate with cladribine tablets 3.5 mg/kg were similar for patients with or without prior high disease activity. Reductions in disability progression with cladribine tablets 3.5 mg/kg were higher in patients with prior high relapse rates with or without prior treatment non-response. In this review, we describe the therapeutic profile of cladribine tablets 3.5 mg/kg and provide practical information on initiating this treatment option in the most appropriate patients.
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Affiliation(s)
- Mohamed AlJumah
- King Fahad Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
| | | | - Shireen Qureshi
- Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
| | | | - Omar Ayoub
- King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saeed A Bohlega
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Areej Bushnag
- International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Edward Cupler
- King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Abdulkader Daif
- King Khaled University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Ahmed Hassan
- King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Yaser Al Malik
- King Saud Bin Abdulaziz University for Health Sciences (KSBU-HS), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Jameelah Saeedi
- King Abdullah Bin Abdulaziz University Hospital, KAAUH, Riyadh, Kingdom of Saudi Arabia
| | | | - Eslam Shosha
- King Khaled Hospital, Al-Majmaah, Kingdom of Saudi Arabia
| | - Peter Rieckmann
- Bamberg Hospital and University of Erlangen, Bamberg, Germany
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Vermersch P, Shanahan J, Langdon D, Yeandle D, Alexandri N, Schippling S. Knowledge Is Power, but Is Ignorance Bliss? Optimising Conversations About Disease Progression in Multiple Sclerosis. Neurol Ther 2020; 9:1-10. [PMID: 31748873 PMCID: PMC7229099 DOI: 10.1007/s40120-019-00170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Communication about multiple sclerosis (MS) disease progression between healthcare professionals (HCPs) and people with MS (PwMS) has historically been considered difficult, and attention to improving it has been neglected. However, a growing number of studies have shown that this is a key area to get right, since negative experiences can affect patient satisfaction, treatment adherence, and clinical outcomes. This article reports on a symposium at the European Charcot Foundation, 2018, led by a panel of leading clinicians and patient experts from MS in the 21st Century, who debated the benefits, drawbacks, and challenges of communicating about disease progression, for both HCPs and PwMS, and potential ways to optimise these discussions. PwMS' preferences and priorities regarding conversations about disease progression vary widely. While the majority want to have these conversations, some will be reluctant and/or emotionally unready. Communication therefore needs to be personalised, and HCPs should always be prepared to have such conversations in an appropriate and sensitive manner. Clinical information can be opaque for PwMS, so HCPs also need to use language that is clear, easily understandable, and patient-friendly. MS in the 21st Century is in the process of developing several resources and programmes to help improve disease progression communication between HCPs and PwMS. FUNDING: Merck KGaA, Darmstadt, Germany. Plain language summary available for this article.
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Affiliation(s)
- Patrick Vermersch
- University of Lille, INSERM U995, CHU Lille, FHU Imminent, 59000, Lille, France.
| | | | - Dawn Langdon
- Royal Holloway, University of London, London, UK
| | - David Yeandle
- MS in the 21st Century Steering Group, Southampton, UK
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Sven Schippling
- Universitätsspital Zürich and Neuroimmunology and Multiple Sclerosis Research, University Hospital Zurich, Zurich, Switzerland
- Center for Neuroscience and Federal Institute of Technology (ETH) Zurich, University of Zurich, Zurich, Switzerland
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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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Carnero Contentti E, López PA, Pettinicchi JP, Alonso R, Tizio S, Tkachuk V, Caride A, Galea I. Do people with multiple sclerosis want to discuss their long-term prognosis? A nationwide study in Argentina. Mult Scler Relat Disord 2020; 37:101445. [DOI: 10.1016/j.msard.2019.101445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022]
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Heesen C, Scalfari A, Galea I. Prognostic information for people with MS: Impossible or inevitable? Mult Scler 2018; 26:771-773. [PMID: 30325713 DOI: 10.1177/1352458518807101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delivering prognostic information is a challenging issue in medicine and has been largely neglected in the past. A major reason has been a suspected nocebo effect of pessimistic estimates, although this is largely unproven. Among people with multiple sclerosis (MS), there is a strong unmet need to receive long-term prognostic information. This viewpoint discusses reasons for this blind spot in physicians' attitude, foremost among which is the uncertainty of prognostic estimates. Possible strategies to move forward include tools to identify matching patients from large well-defined databases, to deliver an evidence-based individualized estimate of long-term prognosis, and its confidence interval, in a clinical setting.
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Affiliation(s)
- Christoph Heesen
- MS Day Hospital and Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonio Scalfari
- Division of Neuroinflammation and Neurodegeneration, Department of Medicine, Imperial College London, London, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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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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