Abstract Details

Title Emotional Expressions associated with Therapeutic Inertia in Multiple Sclerosis care

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-095

Objective

To evaluate emotional expressions when MS neurologists make therapeutic decisions.

Background Therapeutic inertia (TI) affects at least 50% of neurologists who care for patients with multiple sclerosis (MS). It is conceivable that emotions (fear/sadness) protect against or promote TI. However, limited information is available about the emotional expressions at the time of making therapeutic decisions.

Design/Methods

38 neurologists with expertise in MS were invited to participate in a face-to-face study across Canada. Participants answered questions regarding their clinical practice, risk preferences, management of 10 case-scenarios. TI was defined as lack of treatment initiation or escalation when there was clear evidence of clinical and radiological disease activity.

We recorded emotional expressions at stimulus presentation (audio introducing MS case-scenarios under uncertainty) and when facing therapeutic choices. We used a validated machine learning algorithm of the AFFECTIVA software to code for emotional expressions using a predefined mapping of facial muscle movements for emotional expressions (sadness, joy, surprise, etc.) ().

Results 34 (89.4%) neurologists completed the study. Overall, 17 (50%) of participants had TI in at least one case-scenario. At the time of the stimulus presentation, participants with TI had a higher prevalence of brow furrow and inner brow raise [commonly associated with fear and sadness (29.4% vs 8.8%; p<0.001)] compared to participants without TI (p<0.001). At the time of therapeutic choices, participants with TI had higher prevalence of lip pucker [commonly associated with uncertainty (78.1% vs. 21.8%; p<0.03)] and mouth opening (71.1% vs 28.9%; p=0.002). A multivariate analysis adjusted by age and gender revealed that brow furrow at stimulus presentation (OR 1.96; 95%CI 1.12-3.41) and lip pucker at therapeutic decisions (OR 2.37; 95%CI 1.00-5.71) were associated with TI.

Conclusions TI was observed in half of participants in at least one case-scenario. Our data suggest that particularly sadness/fear (brow furrow) and uncertainty (lip pucker) are associated with TI.

Authors/Disclosures
Gustavo Saposnik, MD (Director, Clinical Outcomes & Decision Neuroscience Research Centre) PRESENTER	Dr. Saposnik has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Saposnik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIHSS. The institution of Dr. Saposnik has received research support from Roche. The institution of Dr. Saposnik has received research support from Heart and Stroke Foundation of Canada.
Mariana Espinosa-Polanco	No disclosure on file
Fabien S. Bakdache, PharmD	No disclosure on file
Alonso Montoya, MD (Research and Development Roche Canada)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

��ɫ��

��ɫ��