Abstract Details

Title Therapeutic Decision-making from the Perspective of Patients with Relapsing-remitting Multiple Sclerosis

Topic Multiple Sclerosis

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-008

Objective

The aim of this study was to assess the phenomenon of patients' decisional conflict regarding the choice of a disease-modifying therapy.

Background

Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory and the variety of treatment options with different characteristics of efficacy, safety and administration.

Design/Methods

We conducted a non-interventional, cross-sectional study at 19 hospital-based MS care units in Spain. Adult patients with a diagnosis of relapsing-remitting multiple sclerosis (RRMS) (2017 revised McDonald criteria) and disease duration between 3 and 8 years were included. Decisional conflict was measured using the 4-item Decisional Conflict Scale (SURE). A battery of patient-reported and clinician-rated measures was administered. A multivariate logistic regression analysis was conducted.

Results

A total of 201 patients were included. Mean age (SD) was 38.7 (8.4) years and 74.1% were female. Median disease duration (IQR) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness-related uncertainty, anxiety, depressive symptoms, fatigue, symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. The treatment decisional certainty was associated with MS knowledge (OR=1.18, 95% CI 1.04, 1.33, p=0.011), self-management (OR=1.02, 95% CI 1.00, 1.04, p=0.015), lower illness uncertainty (OR=0.95, 95% CI 0.92, 0.98, p=0.002), and lower healthcare-related regret (OR=0.53, 95% CI 0.29, 0.96, p=0.035) in the multivariable analysis after adjustment for confounders.

Conclusions

Decisional conflict regarding the choice of a disease-modifying therapy was a common phenomenon. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and encourage them to make use of psychological resources even in those who have already been through the initial stage of the disease.

Authors/Disclosures
Miguel Angel Hernandez Perez (Hospital Nuestra Senora de Candelaria) PRESENTER	Miguel Angel Hernandez Perez has nothing to disclose.
Julia Sabin Munoz	Julia Sabin Munoz has nothing to disclose.
Elisa Salas Alonso	Elisa Salas Alonso has nothing to disclose.
Jesus Manuel Martin Martinez	Jesus Manuel Martin Martinez has nothing to disclose.
Antonio Candeliere	Antonio Candeliere has nothing to disclose.
Francisco Barrero	No disclosure on file
Ana M. Alonso Torres, MD	Dr. Alonso Torres has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Alonso Torres has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alonso Torres has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
Jose Luis Sanchez Menoyo, MD (Neurologia - Hospital Galdakao-Usansolo)	Dr. Sanchez Menoyo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Sanchez Menoyo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Sanchez Menoyo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Sanchez Menoyo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Sanchez Menoyo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
Laura Borrega Canelo	Laura Borrega Canelo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BRISTOL. Laura Borrega Canelo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NOVARTIS. Laura Borrega Canelo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MERCK. Laura Borrega Canelo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BRISTOL. Laura Borrega Canelo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NOVARTIS. Laura Borrega Canelo has received research support from BRISTOL.
Maria Rodriguez Rodriguez, MD (Neurologia - Hospital Lucus Augusti)	Maria Rodriguez Rodriguez, MD has nothing to disclose.
Montserrat Gomez Gutierrez	Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a speaker with Roche . Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a speaker with Novartis . Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a speaker with Merck SErono . Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a speaker with Bial. Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a speaker with Bristol Myers Squibb . Montserrat Gomez Gutierrez has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Alnylam .
Sara Eichau Madueno	Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Sara Eichau Madueno has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Sara Eichau Madueno has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Sara Eichau Madueno has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Sara Eichau Madueno has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck.
Carmen Calles, MD (Grupo 7 Viajes)	Dr. Calles has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi, Biogen, Roche, Teva, Novartis, Merck. Dr. Calles has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi, Teva, Biogen, Roche, Novartis, Merck.
Eva Fernandez-Diaz (Complejo Hospitalario Universitario de Albacete)	No disclosure on file
Olga Carmona	Olga Carmona has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Olga Carmona has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NEURAXPHARME. Olga Carmona has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SANOFI. Olga Carmona has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for SANOFI. Olga Carmona has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for NEURAXPHARM.
Aida Orviz-García, MD (Fundacion Jimenez Diaz)	Dr. Orviz-García has nothing to disclose.
Ana Lopez Real	Ana Lopez Real has received personal compensation in the range of $0-$499 for serving as a Consultant for Janssen. Ana Lopez Real has received personal compensation in the range of $0-$499 for serving as a Consultant for Sanofi Genzyme. Ana Lopez Real has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme. Ana Lopez Real has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck.
Pablo Lopez Munoz, MD (Neurologia - Hospital Arnau de Vilanova - Val)	Pablo Lopez Munoz, MD has nothing to disclose.
Amelia Mendoza Rodriguez	Amelia Mendoza Rodriguez has nothing to disclose.
Eduardo Aguera Morales, MD, PhD (As. ENINDE V14776132)	Dr. Aguera Morales has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Aguera Morales has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis .
Jorge Maurino	Jorge Maurino has received personal compensation for serving as an employee of Roche Pharma Spain, Medical Department.

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