Sense making in multiple sclerosis: the information needs of people during an acute exacerbation

Shared decision-making in multiple sclerosis physical symptomatic care: a systematic review

Background

Multiple sclerosis (MS) is a chronic autoimmune inflammatory, demyelinating, and neurodegenerative disease affecting young adults. People with MS are highly interested in engaging in physical symptom management and decision-making but are often not actively engaged in symptom management discussions. Research examining the benefit of shared decision-making in the management of physical MS symptoms is sparse.

Objectives

This study aimed to identify and synthesize the evidence on the use of shared decision-making in physical MS symptom management.

Design

This study is a systematic review of published evidence on the use of shared decision-making in physical MS symptom management.

Data sources and methods

MEDLINE, CINAHL, EMBASE, and CENTRAL databases were searched in April 2021, June 2022, and April 2, 2023, for primary, peer-reviewed studies of shared decision-making in the management of MS physical symptoms. Citations were screened, data extracted, and study quality assessed according to Cochrane guidelines for systematic reviews, including risk of bias assessment. Statistical synthesis of the included study results was not appropriate; results were summarized in a nonstatistical manner using the vote-counting method to estimate beneficial versus harmful effects.

Results

Of 679 citations, 15 studies met the inclusion criteria. Six studies addressed shared decision-making in the management of pain, spasms, neurogenic bladder, fatigue, gait disorder, and/or balance issues, and nine studies addressed physical symptoms in general. One study was a randomized controlled trial; most studies were observational studies. All study results and study author conclusions indicated that shared decision-making is important to the effective management of physical MS symptoms. No study results suggested that shared decision-making was harmful or delayed the management of physical MS symptoms.

Conclusion

Reported results consistently indicate that shared decision-making is important in effective MS symptomatic care. Further rigorous randomized controlled trials are warranted to investigate the effectiveness of shared decision-making associated with MS physical symptomatic care.

Registration

PROSPERO: CRD42023396270.

Health information seeking and people with disability: A systematic search and scoping review

BACKGROUND

Health information and access to it are important aspects of maintaining health. There are 61 million people with disability in the U.S., many of whom experience health disparities. However, it may not be clear to health professionals how people with disability seek health information.

OBJECTIVE

Assess the breadth, examine the characteristics, and evaluate the risk of bias in the existing literature related to health information seeking and people with disability.

METHODS

The authors conducted a systematic search across five databases (Pubmed, Scopus, PsycINFO, HealthSTAR, and CINAHL) to identify empirical journal articles related to health information seeking among people with disability. Analysis of data items and a quality assessment were completed.

RESULTS

Forty-two articles met the criteria for inclusion and were assessed. The articles primarily used survey methodology (50%), and primarily focused on ten disability types, including MS (19%), CP (17%) and general disability (17%). The articles primarily investigated the internet (88%), and healthcare providers (71%) as sources of health information. Trustworthiness (31%), accuracy (29%), and accessibility (29%) were also commonly assessed. The overall quality was high, with room for improvement in minimizing bias.

CONCLUSIONS

The literature addressing health information seeking among people with disability is heterogeneous, but generally of high quality. Future research may benefit from an inclusive definition of disability and a more consistent definition of health information. Focused research on best practices and interactions among sources of health information would be valuable additions.

Modelling the information seeking and searching behaviour of users with impairments: are existing models applicable?

Purpose

A substantial number of models have been developed over the years, with the purpose of describing the information seeking and searching of people in various user groups and contexts. Several models have been frequently applied in user studies, but are rarely included in research on participants with impairments. Models are purposeful when developing theories. Consequently, it might be valuable to apply models when studying this user group, as well. The purpose of this study was to explore whether existing models are applicable in describing the online information seeking and searching of users with impairments, with an overall aim to increase the use of models in studies involving impairments.

Design/methodology/approach

Six models were selected according to the following criteria: the model should address information seeking or searching, include the interaction between users and systems whilst incorporating assistive technology. Two user groups were selected from each of the categories: cognitive, sensory and motor impairments, namely dyslexia, autism, blindness, deafness, paralysation and Parkinson's. The models were then analysed based on known barriers reported for these cohorts.

Findings

All the selected models had potential to be applied in user studies involving impairments. While three of the models had the highest potential to be used in the current form, the other three models were applicable either through minor revisions or by combining models.

Originality/value

This study contributes with a new perspective on the use of models in information seeking and searching research on users with impairments.

Gender differences in information needs and preferences regarding depression among individuals with multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis

OBJECTIVE

We assessed the information needs of persons with any of three immune-mediated inflammatory diseases (multiple sclerosis [MS], inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) regarding depression, as a first step toward developing patient-relevant information resources, ultimately to facilitate self-management and appropriate care. We also compared information needs across genders.

METHODS

We surveyed participants with MS, IBD and RA regarding depression-related information needs including types of treatments, effectiveness, risks, benefits, and perceived helpfulness of treatments. We compared responses between groups using multivariate regression.

RESULTS

328 participants provided complete responses (MS: 141, IBD: 114, RA: 73). Most of the topics queried were perceived as very important, and similarly important for all groups. Women placed higher importance than men on most topics. The most popular formats for receiving information were discussion with a counselor (very preferred: 67.4%) and written information (very preferred: 65.5%); this did not differ between groups.

CONCLUSIONS

Persons affected by MS, IBD and RA are interested in receiving information about multiple topics related to depression treatment, from multiple sources. Women desire more information than men.

PRACTICE IMPLICATIONS

These findings can be used to design information resources to meet information needs regarding depression in MS, IBD and RA.

Caught in a no-win situation: discussions about CCSVI between persons with multiple sclerosis and their neurologists - a qualitative study

Background

In recent years, shared decision making (SDM) has been promoted as a model to guide interactions between persons with MS and their neurologists to reach mutually satisfying decisions about disease management – generally about deciding treatment courses of prevailing disease modifying therapies. In 2009, Dr. Paolo Zamboni introduced the world to his hypothesis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) as a cause of MS and proposed venous angioplasty (‘liberation therapy’) as a potential therapy. This study explores the discussions that took place between persons with MS (PwMS) and their neurologists about CCSVI against the backdrop of the recent calls for the use of SDM to guide clinical conversations.

Methods

In 2012, study researchers conducted focus groups with PwMS (n = 69) in Winnipeg, Canada. Interviews with key informants were also carried out with 15 participants across Canada who were stakeholders in the MS community: advocacy organizations, MS clinicians (i.e. neurologists, nurses), clinical researchers, and government health policy makers.

Results

PwMS reported a variety of experiences when attempting to discuss CCSVI with their neurologist. Some found that there was little effort to engage in desired discussions or were dissatisfied with critical or cautious stances of their neurologist. This led to communication breakdowns, broken relationships, and decisions to autonomously access alternative opinions or liberation therapy. Other participants were appreciative when clinicians engaged them in discussions and were more receptive to more critical appraisals of the evidence. Key informants reported that they too had heard of neurologists who refused to discuss CCSVI with patients and that neurology as a whole had been particularly vilified for their response to the hypothesis. Clinicians indicated that they had shared information as best they could but recommended against seeking liberation therapy. They noted that being respectful of patient emotions, values, and hope were also key to maintaining good relationships.

Conclusions

While CCSVI proved a challenging context to carry out patient-physician discussions and brought numerous tensions to the surface, following the approach of SDM can minimize the potential for unfortunate outcomes as much as possible because it is based on principles of respect and more two-way communication.

Electronic supplementary material

The online version of this article (10.1186/s12883-017-0954-7) contains supplementary material, which is available to authorized users.

Online health information seeking: how people with multiple sclerosis find, assess and integrate treatment information to manage their health

BACKGROUND AND OBJECTIVE

The Internet is increasingly prominent as a source of health information for people with multiple sclerosis (MS). But there has been little exploration of the needs, experiences and preferences of people with MS for integrating treatment information into decision making, in the context of searching on the Internet. This was the aim of our study.

DESIGN

Sixty participants (51 people with MS; nine family members) took part in a focus group or online forum. They were asked to describe how they find and assess reliable treatment information (particularly online) and how this changes over time. Thematic analysis was underpinned by a coding frame.

RESULTS

Participants described that there was both too much information online and too little that applied to them. They spoke of wariness and scepticism but also empowerment. The availability of up-to-date and unbiased treatment information, including practical and lifestyle-related information, was important to many. Many participants were keen to engage in a 'research partnership' with health professionals and developed a range of strategies to enhance the trustworthiness of online information. We use the term 'self-regulation' to capture the variations in information seeking behaviour that participants described over time, as they responded to their changing information needs, their emotional state and growing expertise about MS.

CONCLUSIONS

People with MS have developed a number of strategies to both find and integrate treatment information from a range of sources. Their reflections informed the development of an evidence-based consumer web site based on summaries of MS Cochrane reviews.

Life on hold: the experience of living with neuromyelitis optica

PURPOSE

Neuromyelitis optica (NMO) is a rare autoimmune condition characterised by acute relapses of optic neuritis and extensive transverse myelitis. The aim of this qualitative study was to develop an improved understanding of the experiences of people living with NMO.

METHOD

Fifteen participants completed a semi-structured interview and data were interpreted using a constant comparative method. Participants were recruited from the Northern UK NMO Service.

RESULTS

Five major themes were identified: diagnosis and treatment, symptoms, adjustment, identity and support.

CONCLUSION

Results suggest NMO is a difficult condition to live with due to the unpredictability of relapses and accrued disability of visual or spinal symptoms occurring with each relapse. Poor vision, reduced mobility, bladder dysfunction and pain affected participants' independence and experience of living with NMO. Participants reported that during relapse and recovery they would "put their life on hold". They identified the importance of periods of stability to enable them to adjust to their condition and therefore aim for "normality" of life that they believed was comparable to their peers. Implications for Rehabilitation Disability due to NMO has a major impact on an individual's life, abilities and identity. Timely treatment of relapse is essential to reduce or prevent disability. Health care professionals need to coordinate care locally and nationally. Multi-disciplinary work is vital to promote adjustment, coping strategies and support for people living with NMO.

The path to self-management: a qualitative study involving older people with multiple sclerosis

PURPOSE

This qualitative study sought to explore older people's experience of ageing with multiple sclerosis (MS) and to describe the natural history of self-management from their points of view.

METHODS

Eighteen people over age 55 and living with MS for at least 20 years were recruited from an MS clinic and rehabilitation outpatient records. Interviews (60-80 min), using open-ended questions, explored participants' lifelong experiences of MS. Following interview transcription, data were coded and analyzed; themes, subthemes, and their relationships were described based on consensus.

RESULTS

Participants recounted their diagnosis process, their life experience with MS, and how they eventually accepted their disease, adapted, and moved toward self-management. The findings included vivid descriptions of social relationships, health care interactions, overcoming barriers, and the emotions associated with living with MS. A conceptual model of phases of self-management, from diagnosis to integration of MS into a sense of self, was developed.

CONCLUSIONS

Study participants valued self-management and described its phases, facilitators, and inhibitors from their points of view. Over years and decades, learning from life experiences, trial and error, and interactions with health care professionals, participants seemed to consolidate MS into their sense of self. Self-determination, social support, strong problem-solving abilities, and collaborative relationships with health professionals aided adaptation and coping. Findings from this study make initial steps toward understanding how MS self-management evolves over the life course and how self-management programmes can help people with MS begin to manage wellness earlier in their lives.

The study circle as a tool in multiple sclerosis patient education in Sweden

OBJECTIVE

Patient education plays an important role in the management of chronic diseases that can cause disability and predictable psychosocial problems. Quality of life assessment in multiple sclerosis (MS) has confirmed that psychosocial complications related to working life, marriage/partnership, and the family often occur. Furthermore, symptoms such as fatigue, pain, and sexual dysfunction have a great impact. We wanted to develop and implement study circles to promote the patients' abilities to meet such common problems and to provide a network where they can be autonomous and develop appropriate strategies in self-care and existential problems.

METHODS

Together with the MS patient organization and a study association, we have arranged study circles for patients with MS, thus providing structured information according to a pedagogic model. The patients are encouraged to work together in groups to learn about the disease and its key symptoms, to develop strategies to master these symptoms in everyday life, and to make necessary changes, ie, self-care management. The programme also contains handicap policies.

RESULTS

Fifteen study circles with a total of 105 patients started during the first year. Fifteen circle leaders were approved. A focus interview showed that the patients are highly satisfied but also revealed some problems in interactions with health care professionals. The study circles were included in a wider project from a newly started multidisciplinary centre for health education for a variety of chronic diseases causing disability, which aims at becoming a regional interface between the health care system, patient organizations, and educational services.

CONCLUSION

The study circles have an important role to play in the management of MS. Good organization is required to make such a project work since health care services do not normally work so closely with patient organizations and educational services.

PRACTICE IMPLICATIONS

Study circles that are permanently established and function well are of great help for the patients and the work at the MS clinic is substantially facilitated. Health care professionals also gain from the arrangement by learning more about the self-perceived impact of the disease.

Exploring the personal reality of disability and recovery: a tool for empowering the rehabilitation process

People experiencing disability and chronic disease often feel powerless, relinquishing medical control to "more knowledgeable" professionals. This article presents qualitative and quantitative results from three individual patients experiencing an emerging procedure called Recovery Preference Exploration (RPE). To inspire greater patient involvement, self-direction, and individual choice, we instructed participants to create an imagined recovery path, exposing recovery preferences while learning about clinical rehabilitation concepts. Results uncovered important values and feelings about disability, providing a richer context for patient evaluation and treatment goal modification. Applying mixed methods, RPE is presented as an explanatory process for quantifying recovery preferences in a way that stimulates rich narrative of how people see different types of disabilities. RPE shows promise for increasing depth of discussions among patients, family, and clinicians. RPE may promote greater quality of life through patient empowerment by directed learning, increased communication, and enhanced self-knowledge.

Making Sense of Illness or Disability

This study investigated sense making in multiple sclerosis (MS) and relations with illness, religious-spiritual beliefs and adjustment (life satisfaction, positive states of mind, depression, anxiety). Four hundred and eight persons with MS completed a questionnaire. Half the sample generated sense making explanations for their illness. Content analyses revealed 16 sense making themes. Participants who reported having a religious-spiritual belief were more likely to report sense making than those who did not have such a belief. Sense making was related to lower disability and disease severity and evidenced beneficial direct effects on positive adjustment outcomes and depression after controlling for illness and religious-spiritual belief.

Patient information and coping styles in multiple sclerosis

Background Patients with multiple sclerose (MS) live with their disease for many years. The cause of the disease is unknown and there are no curative therapies. Patients' adaption to chronic disease is dependent on the effectiveness of coping behaviour.

Objectives To explore the correlation between the quality of perceived disease information and to estimate the correspondance between the quality of perceived disease information and later coping styles applied by MS-patients in stress situations related to their disease.

Methods Of a total of 108 patients recently diagnosed with MS, 93 agreed to participate in the study and 86 of these completed two different questionnaires, one assessing quality of the perceived information and the other asessing coping styles (the COPE scale).

Results 43.2% of the patients were dissatisfied or very dissatisfied with the information by the time of diagnosis. MS-related coping styles were influenced by general coping styles and the most frequently employed strategies were `positive reinterpretation and growth', `planning' and `restraint coping' while `denial' was the most infrequently employed strategy. Patients who were satisfied with the information employed avoidance coping to a lesser extent and more actively both plan and seek information about the situation.

Conclusion Optimizing the information process in the early phase of the disease may induce coping styles that produce a better adaption to living with MS. Multiple Sclerosis 2007; 13: 792-799. http:// msj.sagepub.com

Information needs and information sources of individuals living with spinal cord injury

AIMS AND OBJECTIVES

Access to health information is important for the well-being of people living in the community after spinal cord injury (SCI). In order to design appropriate information interventions, it is critical first to understand the information sources typically used. The goal of this study therefore is to identify the information-seeking practices of this group.

SAMPLE AND METHODS

A sample of 207 individuals living in the community following traumatic spinal cord injury were surveyed regarding their ongoing information needs and practices for seeking information.

RESULTS

The results reveal that respondents have unmet information needs, despite the fact that they typically access information through a variety of channels. SCI specialists are the most commonly used source, although they are viewed as relatively inaccessible. By contrast, the Internet (used by a relatively high proportion of respondents) is viewed as comparatively accessible, although there are some concerns about the quality of information found there.

CONCLUSIONS

These survey results point to the need for an information source that is accessible and delivers high quality information. Although respondents use a variety of information sources, none meets this ideal profile. Information professionals should consider this gap in the design of information interventions.

Improving service delivery for relapse management in multiple sclerosis

This action research study was conducted over an 18 month period within a district general hospital. The study has improved the quality of the service provided to people experiencing a relapse of multiple sclerosis. The authors now identify and treat a three-fold increase in relapse patients. At least 85% of these patients are treated within 10 days of reporting symptoms to a specialist nurse. Before the study, only 12% of patients received treatment within this time. The authors' data identify what patients valued about this service and also inform debate around distress associated with relapse and how services should develop to respond to this. The study is of particular importance to the UK because the National Institute for Clinical Excellence (NICE) has published guidance to the NHS about the management of this specific patient group (NICE, 2003). This study also clearly demonstrates how specialist nursing services can combine a substantial clinical role with instigating and managing change in service delivery that results in improvements in patient care.

An assessment of the feasibility and utility of the MS Symptom and Impact Diary (MSSID)

The Multiple Sclerosis Symptom and Impact Diary (MSSID) was developed to provide a more comprehensive assessment of the impact of multiple sclerosis (MS) on HRQoL for use in clinical practice. This paper reports on an assessment of its feasibility and utility in two outpatient samples of people with MS (n = 13 and n = 63) using quantitative and qualitative methods. The response rate in study 2 was 82% and 83% of days were fully completed. Most respondents found the MSSID easy to understand and got into the habit of completing it. Missing items increased over time and those who experienced a relapse had more missing items than those who did not but there was no difference in the number of missed days. Some respondents found completing the MSSID enabled them to manage their lives more effectively and provided useful information to their neurologist. It is concluded that the MSSID is feasible for people with MS to complete and some may find the MSSID helpful as a tool to monitor their condition. Further research is needed to examine clinicians' perceptions of the feasibility and utility of the MSSID within clinical practice.

Taking Part in Life: Enhancing Participation in Multiple Sclerosis

Health care professionals participating in rehabilitation for people with MS can play a critical role in enhancing limited outcomes such as enhanced mobility, reductions in symptoms such as pain and depression, and the metaoutcome-participation. This role will be significantly more effective if the health care professional acknowledges and validates the different perspectives of the professional and the patient and recognizes the expertise of the patient who has lived with MS in the context of his or her life. Assuming this role effectively requires that the health care professional develop a collaborative relationship with the patient and understand that the role may change depending on the stage of MS and the individual's circumstances.

Information-seeking behaviour among people with motor neurone disease

This qualitative study employed indepth, semistructured audiotaped interviews with seven people with motor neurone disease (MND) to explore their desire for information about MND and their experiences in seeking and obtaining such information. Factors affecting their information-seeking behaviour were identified through a process of interpretative phenomenological analysis. Three distinct information-seeking categories emerged. Active seekers personally acquired information from a variety of sources. Selective seekers had access to information but often relied on 'buffers' to filter out unsuitable material. Information avoiders almost always used a 'buffer' to pre-screen any information to which they were exposed. All participants described negative effects on being exposed to unsolicited information, often in the form of media coverage. This work highlights the impact of unsolicited information on people with MND, an area not previously studied.

Management of patients who have relapses in multiple sclerosis

Multiple sclerosis (MS) is a chronic neurological condition, which disrupts the typical functions and daily activities of those affected. Approximately 80% of those diagnosed will follow a relapsing/remitting disease course at diagnosis. Patients with relapsing/remitting MS can expect to have episodes of relapse or an exacerbation of the disease and its variety of symptoms. Management of such episodes has always been open to the preferences of the healthcare professionals involved. The aim of this article is to review the evidence that exists to support current practice in the management of patients during a relapse and to evaluate how this evidence can be incorporated into patient care. The article begins by giving an overview of MS, and continues by determining what a relapse is and discussing the speculated triggers of relapse. Methods of treating relapse are then explored. It concludes by highlighting the strongest evidence-based method for treating relapses, and by emphasizing the need for further research into the pharmaceutical and non-pharmaceutical management of MS relapses.

The MS Symptom and Impact Diary (MSSID): psychometric evaluation of a new instrument to measure the day to day impact of multiple sclerosis

OBJECTIVES

This study aimed to develop further a diary originally devised to measure the impact of multiple sclerosis (MS) as part of a cost utility study of beta interferon, and to evaluate its reliability, validity, and responsiveness in an outpatient sample of people with MS.

METHODS

The original diary was further developed using qualitative and quantitative methods to ensure that it addressed the views of people with MS. The psychometric properties of the MS Symptom and Impact Diary (MSSID) were evaluated in a sample of 77 people who completed the MSSID daily for 12 weeks. Internal and test-retest reliability, discriminant and convergent validity, and responsiveness were assessed using traditional psychometric methods.

RESULTS

The MSSID formed three, internally consistent scales that measured mobility, fatigue, and the overall impact of MS. The test-retest reliability of the mobility scale was adequate for individual comparisons (ICC>0.90) and the fatigue and overall impact scales were adequate for group comparisons (ICC>0.70). The MSSID was able to distinguish between clinical groups depending on clinical course, indoor ambulation status, and relapse status. It demonstrated associations with other single point instruments in the expected direction. Compared with single point instruments, its responsiveness was similar or better, especially in detecting short term improvements in functioning.

CONCLUSIONS

The MSSID may provide a useful complement to currently available instruments to measure the outcomes of MS within clinical trials. Further research is needed to explore its feasibility in the context of a randomised controlled trial and its utility for clinicians.

Health care communication issues in multiple sclerosis: an interpretive description

Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.

Multiple sclerosis: empirical literature for the clinical health psychologist

This article reviews the empirical literature related to clinical health psychology in multiple sclerosis (MS). MS is a disease in which the immune system attacks the central nervous system. As such, the interactions between medical and psychological variables are complex, and potentially of considerable importance to patients. Common neuropsychological and psychological problems associated with MS and their etiologies are reviewed. The effects of stress and depression on MS exacerbation are discussed, including clinical, immune, endocrine, and neuroimaging findings. The types of coping common in MS and their effects on adjustment are discussed. The empirical literature on psychological and neuropsychological intervention is reviewed. The small literature on caregiving in MS is also summarized.