Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis

Background: The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in...

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Autores: Saposnik, G, Andhavarapu, S, Maza, SSD, Castillo-Trivino, T, Borges, M, Baron, BP, Sotoca, J, Alonso, A, Caminero, AB, Borrega, L, Sanchez-Menoyo, JL, Barrero-Hernandez, FJ, Calles, C, Brieva, L, Blasco, MR, -Soto, JDG, del Campo-Amigo, M, Navarro-Canto, L, Agueera, E, Garces, M, Carmona, O, -Torres, LG, Forero, L, Hervas, M, Garcia-Arcelay, E, Terzaghi, M, Gomez-Ballesteros, R, Maurino, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p1293
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/1293
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136518605&doi=10.1016%2fj.msard.2022.104138&partnerID=40&md5=3a5567f2778a73f2ac55fe9dfc647712
Access Level:acceso abierto
Palabra clave:Multiple sclerosis
Status quo bias
Therapeutic inertia
Shared decision-making
Disease-modifying therapy
Patient perspective
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spelling Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosisSaposnik, GAndhavarapu, SMaza, SSDCastillo-Trivino, TBorges, MBaron, BPSotoca, JAlonso, ACaminero, ABBorrega, LSanchez-Menoyo, JLBarrero-Hernandez, FJCalles, CBrieva, LBlasco, MR-Soto, JDGdel Campo-Amigo, MNavarro-Canto, LAgueera, EGarces, MCarmona, O-Torres, LGForero, LHervas, MGarcia-Arcelay, ETerzaghi, MGomez-Ballesteros, RMaurino, JMultiple sclerosisStatus quo biasTherapeutic inertiaShared decision-makingDisease-modifying therapyPatient perspectiveBackground: The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. Methods: We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration <= 18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. Results: Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 & PLUSMN; 9.5 years, 70.7% female, mean disease duration: 1.2 +/- 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (<= 49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (beta coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p < 0.01). Bayesian multi-level model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. Conclusion: Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.ELSEVIER SCI LTD2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://i3pt.portalinvestigacion.com/publicaciones/1293https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136518605&doi=10.1016%2fj.msard.2022.104138&partnerID=40&md5=3a5567f2778a73f2ac55fe9dfc647712Multiple Sclerosis and Related DisordersISSN: 22110348ISSNe: 22110356reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulíinstname:Institut d'Investigació i Innovació Parc Taulí (I3PT)Inglésinfo:eu-repo/semantics/openAccessoai:i3pt.fundanetsuite.com:p12932026-06-21T15:30:37Z
dc.title.none.fl_str_mv Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
title Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
spellingShingle Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
Saposnik, G
Multiple sclerosis
Status quo bias
Therapeutic inertia
Shared decision-making
Disease-modifying therapy
Patient perspective
title_short Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
title_full Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
title_fullStr Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
title_full_unstemmed Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
title_sort Delayed cognitive processing and treatment status quo bias in early-stage multiple sclerosis
dc.creator.none.fl_str_mv Saposnik, G
Andhavarapu, S
Maza, SSD
Castillo-Trivino, T
Borges, M
Baron, BP
Sotoca, J
Alonso, A
Caminero, AB
Borrega, L
Sanchez-Menoyo, JL
Barrero-Hernandez, FJ
Calles, C
Brieva, L
Blasco, MR
-Soto, JDG
del Campo-Amigo, M
Navarro-Canto, L
Agueera, E
Garces, M
Carmona, O
-Torres, LG
Forero, L
Hervas, M
Garcia-Arcelay, E
Terzaghi, M
Gomez-Ballesteros, R
Maurino, J
author Saposnik, G
author_facet Saposnik, G
Andhavarapu, S
Maza, SSD
Castillo-Trivino, T
Borges, M
Baron, BP
Sotoca, J
Alonso, A
Caminero, AB
Borrega, L
Sanchez-Menoyo, JL
Barrero-Hernandez, FJ
Calles, C
Brieva, L
Blasco, MR
-Soto, JDG
del Campo-Amigo, M
Navarro-Canto, L
Agueera, E
Garces, M
Carmona, O
-Torres, LG
Forero, L
Hervas, M
Garcia-Arcelay, E
Terzaghi, M
Gomez-Ballesteros, R
Maurino, J
author_role author
author2 Andhavarapu, S
Maza, SSD
Castillo-Trivino, T
Borges, M
Baron, BP
Sotoca, J
Alonso, A
Caminero, AB
Borrega, L
Sanchez-Menoyo, JL
Barrero-Hernandez, FJ
Calles, C
Brieva, L
Blasco, MR
-Soto, JDG
del Campo-Amigo, M
Navarro-Canto, L
Agueera, E
Garces, M
Carmona, O
-Torres, LG
Forero, L
Hervas, M
Garcia-Arcelay, E
Terzaghi, M
Gomez-Ballesteros, R
Maurino, J
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Multiple sclerosis
Status quo bias
Therapeutic inertia
Shared decision-making
Disease-modifying therapy
Patient perspective
topic Multiple sclerosis
Status quo bias
Therapeutic inertia
Shared decision-making
Disease-modifying therapy
Patient perspective
description Background: The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS. Methods: We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration <= 18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression. Results: Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 & PLUSMN; 9.5 years, 70.7% female, mean disease duration: 1.2 +/- 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (<= 49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (beta coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p < 0.01). Bayesian multi-level model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias. Conclusion: Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://i3pt.portalinvestigacion.com/publicaciones/1293
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136518605&doi=10.1016%2fj.msard.2022.104138&partnerID=40&md5=3a5567f2778a73f2ac55fe9dfc647712
url https://i3pt.portalinvestigacion.com/publicaciones/1293
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136518605&doi=10.1016%2fj.msard.2022.104138&partnerID=40&md5=3a5567f2778a73f2ac55fe9dfc647712
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER SCI LTD
publisher.none.fl_str_mv ELSEVIER SCI LTD
dc.source.none.fl_str_mv Multiple Sclerosis and Related Disorders
ISSN: 22110348
ISSNe: 22110356
reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
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reponame_str r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
collection r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
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