The impact of the face-to-face consultation on decisional conflict in complex decision-making in multiple sclerosis: A pilot study.
Mult Scler J Exp Transl Clin 2020;
6:2055217320959802. [PMID:
33194220 PMCID:
PMC7594484 DOI:
10.1177/2055217320959802]
[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: 03/02/2020] [Accepted: 08/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background
The role of face-to-face consultations in medicine is increasingly being
challenged. Disease activity, national guidelines, life goals e.g.
pregnancy, multiple therapies and side effects need to be considered on
starting disease modifying treatments (DMTs) in people with multiple
sclerosis (pwMS).
Objectives
We studied the impact of a face-to-face consultation on decision making,
using decisional conflict (DC) as the primary outcome.
Methods
Prospective cohort study of 73 pwMS attending clinics who were making
decisions about DMTs followed for one year. Prerequisites and consultation
features were measured with the SURE scale for DC used as the primary
outcome at baseline and at one year.
Results
The patient activation measure (PAM) was the only driver prior to the
consultation associated with DC (p = 0.02) showing those less engaged were
more likely to have DC. Overall, 51/73 (70%) of people made their treatment
decision or reinforced a former decision during the consultation. We found
making a treatment decision between the original consultation and the
follow-up was associated with resolving DC (p = 0.008).
Conclusions
Patient engagement impacts DC but the HCP delivering the optimal Shared
Decision Making (SDM) approach is additionally significant in reducing DC.
In complex decisions there is a clear role for face-to-face consultations in
current practice.
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