Manzano, A orcid.org/0000-0001-6277-3752, Eskyté, I, Ford, HL et al. (8 more authors) (2020) Patient perspective on decisions to switch disease-modifying treatments in relapsing-remitting multiple sclerosis. Multiple Sclerosis and Related Disorders, 46. 102507. ISSN 2211-0348
Abstract
Background
There are now large cohorts of people with relapsing-remitting multiple sclerosis (pwRRMS) who have taken several Disease-Modifying Treatments (DMTs). Studies about switching DMTs mostly focus on clinical outcomes rather than patients' decision-making. Neurologists are now required to support decisions at various times during the relapsing disease course and they do so with concerns about DMTs risks. This qualitative study investigates how pwRRMS weigh up the pros and cons of DMTs, focusing on perceptions of effectiveness and risks when new treatments are considered.
Objective
To increase understanding of people's experiences of decision-making when switching DMTs.
Methods
30 semi-structured interviews were conducted with pwRRMS in England. 16 participants had switched DMT and their experiences were compared with those who had only taken one DMT. Interviews were analysed thematically to answer: what main factors influence people's decision-making to switch DMTs and why?
Results
Of the 16 participants with experience of switching DMT, eight had taken two or more DMTs; eight had taken three or more. Two was the DMT median. This study demonstrated that despite the term "switching" implying that similar treatments are inter-changeable, for pwRRMS taking new treatments involves different emotions, routines, risks, prognosis and communication experiences. Two meta themes identified were: 1) A distinctive, rapid and emotional decision-making process where old emotions related to MS prognosis are revisited. 2) Switching has a different impact on communication for escalation or de-escalation processes.
Conclusion
Switching DMT involves different routines, risks, prognosis and communication experiences. These decisions are emotionally difficult because of the fear about transitioning to secondary progressive MS, and DMT effectiveness uncertainty. Patient centred decision aids should include information about first and consecutive treatment decisions.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020, Elsevier. All rights reserved. This is an author produced version of an article published in Multiple Sclerosis and Related Disorders. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Relapsing-remitting multiple sclerosis; Disease-modifying therapy; CommunicationTherapy switch; Qualitative research; Shared decision-making |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Health Economics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Psychiatry and Behavioural Sciences (Leeds) |
Funding Information: | Funder Grant number Multiple Sclerosis Society Award Ref: 30 |
Depositing User: | Symplectic Publications |
Date Deposited: | 29 Sep 2020 14:46 |
Last Modified: | 19 Sep 2021 00:38 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.msard.2020.102507 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:166061 |
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Filename: Manzanoetal2020_PatientPerspectivesSwitching.pdf
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