Highlights
- •Cognitive profile and physician-based and patients-reported outcomes could have a considerable impact on the disease management and on treatment decision making.
- •According to the Control Preference Scale, more than 50% of patients who needed to change therapy chose a “collaborative” role in making treatment decision.
- •Cognitive profile with SDMT seems to influence patients’ preference on treatment decision.
Abstract
Background
Clinicians are increasingly recognizing the importance of shared decision-making in
complex treatment choices, highlighting the importance of the patient's rationale
and motivation for switching therapies. This study aimed to evaluate the association
between different modalities of changing multiple sclerosis (MS) treatments, cognitive
profile and attitude and preferences of patients concerning treatment choice.
Methods
This multicenter cross-sectional study was conducted at 28 Italian MS centers in the
period between June 2016 and June 2017. We screened all MS patients treated with any
DMT, with a treatment compliance of at least 80% of therapy administered during the
3 last months who needed to modify MS therapy because of efficacy, safety or other
reasons during a follow-up visit. At the time of switching the symbol digit modalities test (SDMT)
and the Control Preference Scale (CPS) were evaluated. According to the CPS, patients
were classified as “active” (i.e. who prefer making the medical decision themselves),
“collaborative” (i.e. who prefer decisions be made jointly with the physician), or
“passive” (i.e. who prefer the physician make the decision).
Results
Out of 13,657 patients recorded in the log, 409 (3%) changed therapy. Of these, 336
(2.5%) patients, 69.6% were female and with mean age 40.6 ± 10.5 years, were enrolled.
According to the CPS score evaluation, a significant high percentage of patients (51.1%)
were considered collaborative, 74 patients (22.5%) were passive, and 60 (18.2%) patients
were active. Stratifying according to CPS results, we found a higher SDMT score among
collaborative patients compared to active and passive ones (45.8 ± 12.3 versus 41.0 ± 13.2
versus 41.7 ± 12.8, p < 0.05).
Conclusion
In this study, the CPS evaluation showed that more than 50% of patients who needed
to change therapy chose a “collaborative” role in making treatment decision. Cognitive
profile with SDMT seems to correlate with patients’ preference on treatment decision,
showing better scores in collaborative patients.
Keywords
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Article info
Publication history
Published online: December 18, 2022
Accepted:
December 18,
2022
Received in revised form:
December 14,
2022
Received:
September 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
