To assess the causes of clinical practice gaps and challenges of healthcare providers specializing in MS (HCP-MS), and associated impact on the care of people with MS.

HCP-MS face an evolving treatment and clinical landscape, with patients requiring advanced care to manage their multi-faceted condition. Therefore, gaps in knowledge, skill and confidence potentially impacting HCP-MS’ ability to make clinical decisions and optimize patient care need assessment.

A mixed-methods study included 333 neurologists and 135 advanced practice nurses in Canada, France, Germany, Italy, Spain, the United Kingdom and the United States, interviewed or surveyed. Qualitative data were analysed thematically. Quantitative data were analysed using ANOVA and Chi-squares for comparison by country, experience, practice setting and MS certification status.

Qualitative data indicate current guidelines are perceived as insufficient to manage the complex needs of people with MS. Tests of cognitive function are perceived as time-consuming, potentially inaccurate, and should preferably be administered by rehabilitation specialists or psychiatrists. Survey data indicate 42% of neurologists and 61% of nurses have no or only basic skills in administering such tests, and 44% and 67% respectively have no/basic skills interpreting them. HCP-MS reported additional factors impeding clinical decision-making for optimal personalized care. Thirty-nine percent of neurologists (higher in Canada/Italy/UK, p<.05) and 44% of nurses report no/basic skills integrating patient goals into treatment recommendations. No/basic skills to make decisions about disease modifying treatment (DMT) sequencing was reported by 28% of neurologists and 62% of nurses. Some adverse events were considered challenging: HCP-MS reported no/basic skills identifying (51%) and managing (61%) infections, and no/basic skills identifying (47%) and managing (56%) cardiac issues.

HCP-MS face significant challenges providing optimal care. This study identified the need for professional development activities to improve skills in cognitive testing, DMT decision-making, treatment monitoring and patient communication, while considering the heterogeneity of MS presentations.