Challenges in multiple sclerosis care: Results from an international mixed-methods study.

Area of Science:

• Neurology
• Clinical Practice
• Healthcare Professional Education

Background:

• Disease-modifying treatment (DMT) selection for multiple sclerosis (MS) is complex.
• Neurologists and advanced practice nurses (APNs) may have knowledge and confidence gaps in DMT initiation, switching, safety assessment, and monitoring.
• Enhanced patient communication, shared decision-making, and adherence assessment are crucial in MS care.

Purpose of the Study:

• To identify challenges faced by neurologists and APNs in DMT selection and MS care across seven countries.
• To understand the causalities behind these challenges to inform educational interventions.
• To improve the optimum care for people with MS (pwMS).

Main Methods:

• A mixed-methods study involving qualitative semi-structured interviews and quantitative online surveys.
• Recruitment of 333 neurologists and 135 APNs with at least two years of experience in MS care.
• International study conducted across Canada, France, Germany, Italy, Spain, United Kingdom, and the United States.

Main Results:

• APNs reported challenges in MS diagnosis, integrating new DMTs, treatment sequencing, monitoring, and personalized care, with significant knowledge and skill gaps.
• Neurologists faced challenges in managing side effects, aligning care with patient goals and quality of life, and identifying treatment failure.
• Differences in confidence levels were noted based on years of practice, and significant country-specific variations were observed.

Conclusions:

• The complexity of MS diagnosis and the array of available DMTs create uncertainties for healthcare professionals.
• Targeted education and training are essential to address identified knowledge and skill deficits.
• Optimizing care for people with MS requires addressing these professional challenges.