The impact of the face-to-face consultation on decisional conflict in complex decision-making in multiple sclerosis: A pilot study

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.

Evaluating the impact of patient-reported outcome measures on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial

“…Patient engagement is feasible, effective, and relevant in chronic medical conditions such as hypertension [ 49 ], diabetes [ 50 ], and heart failure [ 51 ]. In PwMS, higher patient activation is associated with improved depressive symptoms, quality of life, self-efficacy, and fatigue [ 46 , 52 , 53 ] as well as greater confidence in selecting disease modifying therapies in partnership with their MS healthcare providers [ 54 ]. A focus on patient engagement is a relatively novel topic with PwMS, but there was consensus among the Multiple Sclerosis in the 21 st Century Steering Committee (an international working group of both MS experts and patient group representatives) that integration of PROMs into clinical practice may be a means to facilitate patient engagement [ 22 ].…”

Multiple sclerosis disease–related knowledge measurement instruments show mixed performance: a systematic review

“…Therefore, they do not strictly measure knowledge but consider it a subconstruct of the ''activation.'' In addition, both are generic instruments, not specifically targeted at people with MS, although they have been used in studies in the area of MS [46,47]. However, researchers and clinicians should consider other instruments to perform more specific measures of MS-related knowledge.…”

Views of Multiple Sclerosis Patients About Key Elements for a Decision Aid: A Qualitative Study

“…treatments are available for relapsing-remitting MS (RRMS) at different doses and with varying features. 3 Therefore, patients with RRMS may experience decisional conflict at the time of treatment choice. 4 Shared decision making (SDM), a decision-making process shared by patients and their healthcare providers, aims to help patients and clinicians reach a treatment decision considering patients' values.…”

“…4 Shared decision making (SDM), a decision-making process shared by patients and their healthcare providers, aims to help patients and clinicians reach a treatment decision considering patients' values. 3,5 Nurse professionals lead the SDM process by providing patients with support and information during faceto-face clinical encounters. In the Spanish setting, neurologists are legally responsible for prescriptions and therefore participate in the SDM process, making the final treatment decision and prescription.…”

“…2 Several disease-modifying treatments are available for relapsing-remitting MS (RRMS) at different doses and with varying features. 3 Therefore, patients with RRMS may experience decisional conflict at the time of treatment choice. 4…”