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Effect of desire for pregnancy on decisions to escalate treatment in multiple sclerosis care: Differences between MS specialists and non-MS specialists
G. Saposnik, S. Andhavarapu, Ó. Fernández, HJ. Kim, H. Wiendl, M. Foss, F. Zuo, EK. Havrdová, EG. Celius, F. Caceres, M. Magyari, R. Bermel, A. Costa, M. Terzaghi, T. Kalincik, V. Popescu, MP. Amato, X. Montalban, J. Oh
Jazyk angličtina Země Nizozemsko
Typ dokumentu časopisecké články
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologové MeSH
- roztroušená skleróza * farmakoterapie MeSH
- specializace MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Therapeutic inertia (TI) is a worldwide phenomenon that affects 60 to 90% of neurologists and up to 25% of daily treatment decisions during management of multiple sclerosis (MS) patients. A large volume of MS patients are women of childbearing age, and desire for pregnancy is a complex variable often affecting MS care. The objective of this study was to determine the effect of desire for pregnancy on decisions to escalate treatment during management of MS patients. METHODS: 300 neurologists with expertise in MS from 20 countries were invited to participate in the study. Participants were presented with 12 pairs of simulated MS patient profiles reflective of case scenarios encountered in clinical practice. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. Disaggregated discrete choice experiments were used to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. An excel calculator that provides estimates as the percentage of participants that would escalate treatment for a simulated case-scenario was constructed. RESULTS: 229 (76.3%) completed the study. The mean age (SD) of study participants was 44 (±10) years. The mean (SD) number of MS patients seen per month by each neurologist was 18 (±16). Non-MS specialists were significantly less likely to escalate treatment than MS specialists across mild, moderate, and severe patient cases. These differences were accentuated when case scenarios introduced a desire for pregnancy. The findings were consistent when MRI-lesions, severity of symptoms, and number of relapses were included. CONCLUSIONS: Desire for pregnancy differentially influences decisions to escalate treatment, suggesting knowledge-to-action gaps between MS and non-MS specialists. Our findings indicate the need for educational strategies to overcome these gaps and improve clinical outcomes for MS patients who desire pregnancy.
Bootstrap Analytics Calgary Canada
CORe Department of Medicine University of Melbourne SA
Danish Multiple Sclerosis Center University Hospital Rigshospitalet Copenhagen Denmark
Department NEUROFARBA University of Florence Italy
Department of Neurology Cemcat Hospital Vall d ́Hebron Universitat Autonoma de Barcelona Spain
Department of Neurology Research Institute and Hospital of National Cancer Center Goyang Korea
Department of Neurology with Institute of Translational Neurology University of Münster Germany
Division of Neurology Department of Medicine St Michael's Hospital University of Toronto Canada
Hasselt University Hasselt Belgium
Institute of Restorative Neurosciences Buenos Aires Argentina
IRCCS Fondazione Don Carlo Gnocchi Florence Italy
Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Canada
Mellen Center for Multiple Sclerosis Cleveland Clinic Cleveland OH United States
MS Centre Royal Melbourne Hospital Melborne Australia
University MS Centre Noorderhart Hospital Pelt Belgium
Zurich Center for Neuroeconomics Department of Economics University of Zurich Switzerland
Citace poskytuje Crossref.org
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- $a Saposnik, Gustavo $u Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Switzerland; Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada. Electronic address: gustavo.saposnik@unityhealth.to
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- $a BACKGROUND: Therapeutic inertia (TI) is a worldwide phenomenon that affects 60 to 90% of neurologists and up to 25% of daily treatment decisions during management of multiple sclerosis (MS) patients. A large volume of MS patients are women of childbearing age, and desire for pregnancy is a complex variable often affecting MS care. The objective of this study was to determine the effect of desire for pregnancy on decisions to escalate treatment during management of MS patients. METHODS: 300 neurologists with expertise in MS from 20 countries were invited to participate in the study. Participants were presented with 12 pairs of simulated MS patient profiles reflective of case scenarios encountered in clinical practice. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. Disaggregated discrete choice experiments were used to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. An excel calculator that provides estimates as the percentage of participants that would escalate treatment for a simulated case-scenario was constructed. RESULTS: 229 (76.3%) completed the study. The mean age (SD) of study participants was 44 (±10) years. The mean (SD) number of MS patients seen per month by each neurologist was 18 (±16). Non-MS specialists were significantly less likely to escalate treatment than MS specialists across mild, moderate, and severe patient cases. These differences were accentuated when case scenarios introduced a desire for pregnancy. The findings were consistent when MRI-lesions, severity of symptoms, and number of relapses were included. CONCLUSIONS: Desire for pregnancy differentially influences decisions to escalate treatment, suggesting knowledge-to-action gaps between MS and non-MS specialists. Our findings indicate the need for educational strategies to overcome these gaps and improve clinical outcomes for MS patients who desire pregnancy.
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