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Téllez-Lara N, Gómez-Ballesteros R, Sepúlveda M, Orviz A, Díaz-Sánchez M, Boyero S, Aguado-Valcarcel M, Cobo-Calvo Á, López-Laiz P, Rebollo P, Maurino J. Preferences for neuromyelitis optica spectrum disorder treatments: A conjoint analysis with neurologists in Spain. Mult Scler Relat Disord 2024; 88:105732. [PMID: 38936324 DOI: 10.1016/j.msard.2024.105732] [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: 09/14/2023] [Revised: 01/02/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The treatment landscape for neuromyelitis optica spectrum disorder (NMOSD) has changed in recent years with the approval of therapies with different efficacy, safety and administration profiles. OBJECTIVE The aim of this study was to assess neurologists' preferences for different NMOSD treatment attributes using conjoint analysis (CA). METHODS We conducted an online, non-interventional, cross-sectional study in collaboration with the Spanish Society of Neurology. Our CA assessed five drugs' attributes: prevention of relapse, prevention of disability accumulation, safety risk, management during pregnancy, and route and frequency of administration. Participants were presented with eight hypothetical treatment scenarios to rank based on their preferences from the most preferred to the least. An ordinary least squares method was selected to estimate weighted preferences. RESULTS A total of 104 neurologists were included. Mean age (standard deviation-SD) was 37.7 (10.3) years, 52.9 % were male, and median time (interquartile range) of experience managing NMOSD was 5.0 (2.9, 10.8) years. Neurologists placed the greatest importance on efficacy attributes, time to relapse (44.1 %) being the most important, followed by preventing disability accumulation (36.8 %). In contrast, route and frequency of administration (4.6 %) was the least important characteristic. Participants who prioritised efficacy attributes felt more comfortable in decision-making, had fewer past experiences of care-related regret and a lower attitude to risk taking than their counterparts. CONCLUSION Neurologists' treatment preferences in NMOSD were mainly driven by efficacy attributes. These results may be useful to design policy decisions and treatment guidelines for this condition.
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Affiliation(s)
- Nieves Téllez-Lara
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Sepúlveda
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Díaz-Sánchez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | | | - Álvaro Cobo-Calvo
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Pastore F, Sanchez MAR, Harrison CM, Ntinoulis K, Staller S, Theano T, Shirol SB. The Clinical Nurse Practitioner's Essential Role in Early Diagnosis and Management of Multiple Sclerosis in Europe: A Consensus Report. Int J MS Care 2024; 26:208-213. [PMID: 39105046 PMCID: PMC11298979 DOI: 10.7224/1537-2073.2023-070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Timely diagnosis of multiple sclerosis (MS) is a challenge due to factors such as prompt identification of symptoms and consequent delays in hospital visits and treatment initiation. In part to address this challenge, an expert scientific advisory panel of clinical nurse practitioners (CNPs) from different European nations was convened by Viatris on October 25, 2022, in Amsterdam, the Netherlands. This meeting was an interactive discussion to understand the role of clinical nurse practitioners in MS management. The objectives were to (1) understand the current delays in MS diagnosis from the perspective of expert CNPs; (2) determine the role of the CNP in MS management; and (3) identify the opportunities to improve accessibility, foster collaboration among stakeholders, and promote initiatives to educate people with MS. The recommendations of the panel underline the multidimensional role of CNPs in the management of MS at all stages. Health care stakeholders need to work together to achieve better access to treatment regimens and facilitate outcomes in the management of MS through shared decision-making and follow-ups. Further exploration of the role of CNPs in the management of MS, as well as recommendations for early diagnosis, will help both general practitioners and specialists better manage MS care.
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Affiliation(s)
- Francesco Pastore
- From the Department of Biomedicine and Prevention, TorVergata University, Rome, Italy
- University Hospital Polyclinic of Bari, Department of Translational Biomedicine and Neurosciences, MS Centre Bari, Italy
| | - Miguel Angel Robles Sanchez
- Multidisciplinary Nursing Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Neurology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Faculty of Nursing, University of Girona, Girona, Spain
| | | | | | | | - Tatsi Theano
- Multiple Sclerosis Centre, Second Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece
| | - Santosh B. Shirol
- Global Noncommunicable Diseases team, Viatris Pharmaceuticals, Kadubeesanahalli, Bangalore, India
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Redaelli S, Martineau C, Pelé F, Créange A. [Role of the MS nurse specialist in the patient's care pathway]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:19-22. [PMID: 37037638 DOI: 10.1016/j.soin.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The specialized nurse in MS is a new profession practiced in MS clinics and outpatients specialized coordination structures. She is part of a specialized multi-professional team. The nurse must master a broad knowledge of the disease and the treatments. Have skills in therapeutic education, communication and coordination. She has a detailed knowledge of the resources of the care offer. The MS nurse thus participates in the assessment of the patient's needs for the implementation of a personalized care plan combining response to medical, paramedical, psychological and social needs.
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Affiliation(s)
- Sophie Redaelli
- Service de neurologie, centre hospitalier universitaire Henri-Mondor, AP-HP Paris Est, 1 rue Gustave-Eiffel, 94000 Créteil, France; Centre de ressources et de compétences Grand Paris Est, centre hospitalier universitaire Henri-Mondor, AP-HP Paris Est, 1 rue Gustave-Eiffel, 94000 Créteil, France; Réseau sclérose en plaques et maladies inflammatoires du système nerveux (SINDEFI-SEP) Île-de-France, immeuble Expansion, 9/11 rue Georges-Enesco, 94000 Créteil, France.
| | - Clémence Martineau
- Réseau sclérose en plaques et maladies inflammatoires du système nerveux (SINDEFI-SEP) Île-de-France, immeuble Expansion, 9/11 rue Georges-Enesco, 94000 Créteil, France
| | - Fabienne Pelé
- Réseau sclérose en plaques et maladies inflammatoires du système nerveux (SINDEFI-SEP) Île-de-France, immeuble Expansion, 9/11 rue Georges-Enesco, 94000 Créteil, France
| | - Alain Créange
- Service de neurologie, centre hospitalier universitaire Henri-Mondor, AP-HP Paris Est, 1 rue Gustave-Eiffel, 94000 Créteil, France; Centre de ressources et de compétences Grand Paris Est, centre hospitalier universitaire Henri-Mondor, AP-HP Paris Est, 1 rue Gustave-Eiffel, 94000 Créteil, France; Réseau sclérose en plaques et maladies inflammatoires du système nerveux (SINDEFI-SEP) Île-de-France, immeuble Expansion, 9/11 rue Georges-Enesco, 94000 Créteil, France
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Ballesteros J, Bueno-Gil G, Rodríguez-Antigüedad A, Sempere ÁP, del Río B, Baz M, Medrano N, Saposnik G, Maurino J. Assessing care-related regret among nurses specialized in multiple sclerosis: A psychometric analysis of a new assessment battery. Mult Scler J Exp Transl Clin 2022; 8:20552173221144226. [PMCID: PMC9742695 DOI: 10.1177/20552173221144226] [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: 10/04/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Experiences of regret associated with caring for patients with multiple sclerosis (MS) can affect medical decisions. A non-interventional study was conducted to assess the dimensionality and item characteristics of a battery including the Regret Intensity Scale (RIS-10) and 15 items evaluating common situations experienced by nurses in MS care. A total of 97 nurses were included. The RIS-10 showed good internal reliability and a unidimensional structure according to Mokken analysis. All-item homogeneity coefficients exceeded 0.30, whereas scalability for the overall RIS-10 was 0.66, indicating a strong scale. This battery showed adequate psychometric properties to evaluate regret among MS nurses.
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Affiliation(s)
- Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of the Basque Country (UPV/EHU), Leioa, Spain
| | | | | | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Beatriz del Río
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mar Baz
- Department of Psychiatry, Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | | | - Gustavo Saposnik
- Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada,Division of Neurology, Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Jorge Maurino
- Jorge Maurino
Medical Department, Roche Farma, Ribera del Loira, 50, Madrid 28042, Spain.
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Artola M, Hernando A, Vidal O, Vidal N, Cuenca E, Horno R, Robles MÁ, Oriol C, Peralta S, Solana MAJ, Rubio M, Montero C, Lleixà M, Zabay C, Martin M, Leon I, Molinos C, Matamoros M, Mercadé L, Fornali O, Montero L, Saiz A, Solà-Valls N. The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis. J Clin Nurs 2022. [PMID: 35799407 DOI: 10.1111/jocn.16421] [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: 11/11/2021] [Revised: 04/14/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). OBJECTIVES To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. DESIGN Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. METHODS Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. RESULTS Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0-8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). CONCLUSIONS Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. PATIENT CONTRIBUTION Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.
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Affiliation(s)
- Montse Artola
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Ana Hernando
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Oscar Vidal
- Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Núria Vidal
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ester Cuenca
- Hospital Residencia Sant Camil, Sant Pere de Ribes, Barcelona, Spain
| | - Rosalía Horno
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miguel Ángel Robles
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Clara Oriol
- Centre d'Esclerosi Múltiple de Catalunya, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Matilde Rubio
- Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Cristina Montero
- Hospital de Figueres, Fundació Salut Empordà, Figueres, Girona, Spain
| | - Mercè Lleixà
- Hospital de Sant Joan Despí-Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Cinta Zabay
- Centre Neurorehabilitador Mas Sabaté, Fundació Esclerosi Multiple, Reus, Tarragona, Spain
| | - Montse Martin
- Hospital Sant Joan de Déu Althaia de Manresa, Manresa, Barcelona, Spain
| | - Isabel Leon
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Consuelo Molinos
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mandi Matamoros
- Hospital Verge de la Cinta de Tortosa, Tortosa, Tarragona, Spain
| | | | | | | | - Albert Saiz
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain
| | - Núria Solà-Valls
- Unidad de Neuroinmunología- Esclerosis múltiple, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
- Universitat de Barcelona, Barcelona, Spain.,Secció de Neurologia, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
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Saposnik G, Camacho A, Díaz-Abós P, Brañas-Pampillón M, Sánchez-Menéndez V, Cabello-Moruno R, Terzaghi M, Maurino J, Málaga I. Therapeutic Decision-Making Under Uncertainty in the Management of Spinal Muscular Atrophy: Results From DECISIONS-SMA Study. Neurol Ther 2022; 11:1209-1219. [PMID: 35657490 PMCID: PMC9338192 DOI: 10.1007/s40120-022-00366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction There are many uncertainties about treatment selection and expectations regarding therapeutic goals and benefits in the new landscape of spinal muscular atrophy (SMA). Our aim was to assess treatment preferences and expectations of pediatric neurologists caring for patients with SMA. Methods DECISIONS-SMA is a non-interventional, cross-sectional pilot study that assessed pediatric neurologists with expertise in SMA from across Spain. Participants were presented with 11 simulated case scenarios of common encounters of patients with SMA type 1 and 2 to assess treatment initiation, escalation, or switches. We also asked for the expected benefit with new therapies for four simulated case scenarios. Participants completed a behavioral battery to address their tolerance to uncertainty and aversion to ambiguity. The primary outcome was therapeutic inertia (TI), defined as the number of simulated scenarios with lack of treatment initiation or escalation when warranted over the total (11) presented cases. Results A total of 35 participants completed the study. Participants’ mean (SD) expectation for achieving an improvement by starting a new therapy for SMA type 1 (case 1, a 5-month-old) and SMA type 2 (case 6, a 1-year-old) were both 59.6% (± 21.8), but declined to 20.2% (± 12.2) for a case scenario of a 16-year-old treatment-naïve patient with long-standing SMA type 2 with severe disability. The mean (SD) TI score was 4.2 (1.7), and 3.29 (1.5) for treatment initiation. Of a total 385 individual responses, TI was observed in 147 (38.2%) of treatment choices. The multivariable analysis showed that lower aversion to ambiguity (p = 0.019) and lower expectation of treatment response (p = 0.007) were associated with higher TI after adjustment for participants’ age and years of experience. Older age (p = 0.019), lower years of experience (p = 0.035), lower aversion to ambiguity (p = 0.015), and lower expectation of treatment benefits (p = 0.006) were associated with inertia for treatment initiation. Conclusions Pediatric neurologists managing patients with SMA were optimistic regarding treatment improvement in cases with early diagnosis, but had lower expectations when treatment delays and advanced patient age were present. Low aversion to ambiguity, low expectation of treatment benefits, and lower clinical experience were more likely to make suboptimal decisions, resulting in lack of treatment initiation, escalation, and TI. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00366-4.
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Affiliation(s)
- Gustavo Saposnik
- Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada. .,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Ana Camacho
- Division of Child Neurology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | | | | | - María Terzaghi
- Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada
| | | | - Ignacio Málaga
- Child Neurology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
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