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. 2020 Oct 20;6(4):2055217320959802.
doi: 10.1177/2055217320959802. eCollection 2020 Oct-Dec.

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

David Daniel Wilkie  1 , Alessandra Solari  2 , Richard St John Nicholas  1
Affiliations

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

David Daniel Wilkie et al. Mult Scler J Exp Transl Clin. .

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.

Keywords: Multiple sclerosis; decision-making; disease modifying therapies; patient engagement; shared decision making.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Alessandra Solari (AS) was board member of Merck Serono and Novartis, and received speaker honoraria from Almirall, Excemed, Genzyme, Merck Serono and Teva. Richard Nicholas (RN) received speaker honoraria from Biogen, Novartis and Roche and is funded by the Imperial Biomedical Research Centre (BRC). David Wilkie (DW) is funded by Multiple Sclerosis Trials Collaboration (MSTC).

Figures

Figure 1.
Figure 1.
Flow-chart of patient participation per study phase showing questionnaires completed.
Figure 2.
Figure 2.
The decisional process model: showing the instruments mapped across the decisional process: prerequisites, the consultation and the outcome measures including treatment choice and DC.
Figure 3.
Figure 3.
Treatment decision ‘followed through’ as measured by time from consultation. Decisions made after the consultation result in treatment initiation, improved treatment satisfaction and reduced DC.
See this image and copyright information in PMC

References

    1. Gallagher SM. Paternalism in healthcare decision making. Ostomy Wound Manage 1998; 44: 24–25. - PubMed
    1. Gerber BS, Eiser AR. The patient-physician relationship in the internet age: future prospects and the research agenda. J Med Internet Res 2001; 3: E15. - PMC - PubMed
    1. Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler 2018; 24: 96–120. - PubMed
    1. Kennedy P. Impact of delayed diagnosis and treatment in clinically isolated syndrome and multiple sclerosis. J Neurosci Nurs 2013; 45: S3–S13. - PubMed
    1. Wingerchuk DM, Weinshenker BG. Disease modifying therapies for relapsing multiple sclerosis. Br Med J 2016; 354: i3518. - PubMed

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