Multiple sclerosis patients talking with healthcare providers about emotions

Implementing a new clinical service - what's your elevator pitch?

BACKGROUND

People with multiple sclerosis (PwMS) identify emotional well-being as a key unmet care need. Mindfulness-based interventions (MBI) can improve emotional well-being in PwMS; however, there is a lack of information on their implementation in routine care. Healthcare policy influencers may provide critical insight as to the implementation process. The aim of this study was to explore the needs and priorities of healthcare policy influencers for implementing MBIs for PwMS in Canada.

METHODS

A qualitative descriptive approach was adopted using semi-structured interviews with an inductive thematic analysis. Healthcare policy influencers (e.g., senior clinical leaders, provisional health service commissioners, healthcare policymakers) in various settings across Ontario were recruited.

RESULTS

Twelve individuals with an average age of 51.1 ± 8.9 years participated in the semi-structured interviews. Interviews ranged from 12 to 60 min. Four themes were identified in thematic analysis: (1) Need for evidence with a personal connection is foundational; (2) People Power: Need for Implementation champions; (3) Finding its place: Need for embedding interventions into existing systems; and (4) Sustainability: Need for focus on long-term impact.

CONCLUSION

Our study provides novel insight into complex factors which affect implementation of new interventions, such as MBIs for PwMS, into the healthcare landscape in Ontario. Six key steps were identified for implementors to consider when seeking to implement a new intervention: (1) identify the problem and the need for intervention, (2) establish evidence highlighting evidence of effectiveness for an intervention, (3) build a team of implementation champions, (4) pilot the novel intervention to establish proof of concept, feasibility, and ecological integration within current landscape, (5) identify decision makers for intervention implementation, and (6) develop an 'elevator pitch' for decision makers. The implementation process is convoluted and can lack clarity. This is a major challenge for implementers. We have identified six key steps for implementers to consider, making this process more transparent and hopefully more successful. Future research should explore, test, and bridge the gaps in the implementation pathway we have identified, as this may be critical in closing the gaps that exist in our healthcare systems.

Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review

OBJECTIVE

Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS.

METHODS

Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings.

RESULTS

Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS.

CONCLUSIONS

A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.

Communication between persons with multiple sclerosis and their health care providers: A scoping review

OBJECTIVES

This study undertakes a scoping review of research about communication between persons with MS and their health care providers.

DESIGN

PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information.

RESULTS

Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making.

CONCLUSION

This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes.

PRACTICE IMPLICATIONS

Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.

Giving and receiving a diagnosis of a progressive neurological condition: A scoping review of doctors' and patients' perspectives

OBJECTIVE

Delivering a life changing diagnosis can be a distressing experience for patients and a challenging task for professionals. Diagnosis delivery can be especially difficult for individuals with neurodegenerative diseases such as motor neurone disease (MND), multiple sclerosis (MS) and Parkinson's disease (PD). This review aims to scope the literature on doctors' and patients' perspectives on diagnosis delivery for these conditions in order to enhance our understanding in this area and identify potential research gaps.

METHODS

A scoping review methodology was used, and data were summarised using content analysis.

RESULTS

47 studies fulfilled the inclusion criteria. Studies showed that although patients were generally satisfied with diagnosis delivery, a considerable proportion was still dissatisfied with aspects of the consultation, especially the information and time provided and the doctor's approach. Only six studies addressed doctors' perspectives, which focused more on doctors' practice.

CONCLUSION

There was a significant research gap in professionals' perspectives. The review also found that although basic standards of good practice were being met, a significant proportion of patients were dissatisfied with diagnosis communication.

PRACTICE IMPLICATIONS

Professionals delivering such diagnoses need to assess and respond to patients' information needs, provide time for questions and maintain an empathic attitude.

Patient expression of emotions and neurologist responses in first multiple sclerosis consultations

BACKGROUND

Anxiety and depression are common in people with multiple sclerosis (MS), but data on emotional communication during MS consultations are lacking. We assessed patient expressions of emotion and neurologist responses during first-ever MS consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).

METHODS

We applied VR-CoDES to recordings/transcripts of 88 outpatient consultations (10 neurologists, four MS Italian centers). Before consultation, patients completed the Hospital Anxiety and Depression Scale (HADS). Multilevel sequential analysis was performed on the number of cues/concerns expressed by patients, and the proportion of reduce space responses by neurologists.

RESULTS

Patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The commonest cues were verbal hints of hidden worries (cue type b, 41%) and references to stressful life events (type d, 26%). Variables independently associated with number of cues/concerns were: anxiety (HADS-Anxiety score >8) (incidence risk ratio, IRR 1.08, 95% CI 1.06-1.09; p<0.001); patient age (IRR 0.98, 95% CI 0.98-0.99; p<0.001); neurologist age (IRR 0.94, 95% CI 0.92-0.96; p=0.03); and second opinion consultation (IRR 0.72, 95% CI 0.60-0.86; p=0.007). Neurologists reacted to patient emotions by reducing space (changing subject, taking no notice, giving medical advice) for 58% of cues and 76% of concerns. Anxiety was the only variable significantly associated with 'reduce space' responses (odds ratio 2.17, 95% CI 1.32-3.57; p=0.003).

CONCLUSIONS

Patient emotional expressions varied widely, but VR-CoDES cues b and d were expressed most often. Patient anxiety was directly associated with emotional expressions; older age of patients and neurologists, and second opinion consultations were inversely associated with patient emotional expression. In over 50% of instances, neurologists responded to these expressions by reducing space, more so in anxious patients. These findings suggest that neurologists need to improve their skills in dealing with patient emotions.

The care continuum in acromegaly: how patients, nurses, and physicians can collaborate for successful treatment experiences

Patients with acromegaly (a condition of chronic growth hormone hypersecretion by a pituitary adenoma) often require pharmacological treatment. Somatostatin analogs (SSAs) such as pasireotide, lanreotide, and octreotide are frequently used as first-line medical therapy. As SSAs are delivered by regular subcutaneous or intramuscular injections, they can result in injection-related pain or anxiety and can be challenging to fit into patients' lifestyles. When combined with the prolonged, debilitating psychological complications associated with acromegaly, these administration challenges can negatively impact compliance, adherence, and quality of life. Proactively managing patients' expectations and providing appropriate, timely guidance are crucial for maximizing adherence, and ultimately, optimizing the treatment experience. As part of ongoing clinical research since 1997, our team at the University of Michigan has used SSAs to treat 30 patients with acromegaly. Based on our clinical experiences with multiple SSA administration regimens (long-acting intramuscular, long-acting deep subcutaneous, and twice-daily subcutaneous), we generated a dialog map that guides health care professionals through the many sensitive and complex patient communication issues surrounding this treatment process. Beginning with diagnosis, the dialog map includes discussion of treatment options, instruction on proper drug administration technique, and ensuring of appropriate follow-up care. At each step, we provide talking points that address the following: the patients' clinical situation; their geographic, economic, and psychological concerns; and their inclination to communicate with clinicians. We have found that involving patients, nurses, and physicians as equal partners in the treatment process optimizes treatment initiation, adherence, and persistence in acromegaly. By encouraging collaboration across the care continuum, this dialog map can facilitate identification of the treatment plan that is most likely to yield the best possible outcome.

Challenging nurses' cultural competence of disability to improve interpersonal interactions

Worldwide, at least 6.9 billion people have an impairment-producing health condition. Insensitive encounters with healthcare providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge, (b) detached interpersonal interactions, (c) placing a negative skew on their life quality, (d) lack of HCP knowledge related to their complete needs, (e) assuming they should be asexual and childless, and (f) an inherent power differential. The medical model of disability is perceived by individuals with impairment-producing health conditions to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address educational needs, plan future research questions, and establish clinical practice improvements.

Unmet needs of severely affected multiple sclerosis patients: the health professionals' view

BACKGROUND

Research has only started recently to specifically concentrate on the group of patients severely affected by multiple sclerosis (MS).

AIM

The aim of this study was to assess the perception on patients' unmet needs by healthcare professionals.

METHODS

Focus groups and expert interviews were recorded, transcribed verbatim and analysed by qualitative content analysis.

RESULTS

Unmet needs were identified in four main categories ('support from family/friends'; 'healthcare services'; 'managing everyday life'; 'maintaining biographical continuity'). Whereas physicians assessed most unmet needs in the category 'healthcare services', nurses and social workers focussed on unmet needs in the categories 'support from family/friends' and 'maintaining biographical continuity'. Although the study focused on unmet needs of patients, professionals also voiced their unmet needs when caring for these patients. The group of professionals identified more subcategories than patients and included unmet needs of relatives.

CONCLUSION

Adding professionals' perspective to that of patients is essential to gain a holistic view on patients' unmet needs and to further optimize their care. The perspective of palliative care might contribute to meet unmet needs of severely affected MS patients.

Factors that influence adherence and strategies to maintain adherence to injected therapies for patients with multiple sclerosis

A key aspect of the management of care for patients with multiple sclerosis (MS) is identifying which patients are struggling with adherence. Disease-modifying therapies for the treatment of MS are primarily preventative, with modest efficacy, and they can possibly cause significant side effects. These factors can lead patients to stop taking their medication because they continue to experience symptoms or relapses of the disease, and/or they have painful injection-site reactions on most parts of their bodies. However, striving for 100% adherence to the prescribed treatment regimen remains the goal and is the surest way to reap all the benefits associated with immunomodulatory therapy. Building trust, promoting injection self-efficacy, and educating patients about proper injection techniques to prevent injection-site reactions have the greatest impact on patient adherence. Factors including family involvement, financial stability and support, hope, and faith can also have a positive impact on adherence. Identifying patients who may be struggling with depression, which is easily treatable but often not well addressed, and providing access to mental health services are important. Although many strides have been made with regard to MS patient care, outlining strategies that can maintain or encourage adherence can provide practitioners with tools to facilitate their patients' health and well-being.