Assessing diagnosis disclosure and concealment in multiple sclerosis: Development and initial validation of the DISCO-MS survey

Concealment of Parkinsons disease prevalence and impact on health and quality of life

Concealment of diagnosis in chronic conditions has proven benefits as a coping strategy to avoid stigmatization and discrimination and allows people to be treated "normally" by society. However, concealment is related to negative health, physical, quality of life outcomes, exhaustion and loneliness. In addition, diagnosis concealment has a detrimental impact on self-management behaviors. In Parkinson's disease (PD), information regarding the aspects related to concealment is limited. A better understanding of the contributors and consequences of concealment in PD may facilitate the development of strategies to support patients who conceal. We conducted a cross-sectional study to explore concealment in PD by examining rates of diagnosis concealment and associations of concealment with socio-demographic factors, self-management behaviors, stigma, social support, and quality of life. The study was conducted at an outpatient movement disorders clinic or at the participant's home, at the participant's preference. One hundred and fifty people with PD completed questionnaires assessing disclosure of their diagnosis,  socio-demographic variables, disease severity, self-management behaviors (knowledge, activation, exercise), stigma, social support, and health-related quality of life (HRQoL). Differences between disclosers and concealers were analyzed and associations between disclosure, stigma, social support and emotional aspects of HRQoL were tested using mediation models. Close to one-quarter (22.7%) conceal their PD diagnosis from their family. Concealers were more often women, Muslim, religious, and lacking academic degrees compared to disclosers. Concealers also had lower patient activation, and less social support. They engaged less in physical activity and experienced greater stigma. Concealment had a significant total effect on lower emotional aspects of HRQoL, mediated by greater stigma but not by social support. Healthcare providers should be attuned to both the prevalence of PD diagnosis concealment and its detrimental impacts on patients' emotional support needs and facilitation of health behaviors. Moreover, treating neurologists should deliver diagnoses carefully, discuss disclosure consequences, maintain open dialogue on concealment, and advise informing family. Interventions targeting stigma reduction in this population may have downstream benefits for emotional aspects of HRQoL.Trial registration: NCT05209698; Registration Date: 23/1/2022.

Disclosing or concealing multiple sclerosis in the workplace: two sides of the same coin-insights from a Swedish population-based survey

Background

People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS.

Objectives

To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced.

Methods

A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis.

Results

It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS.

Conclusion

PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes.

Patients experiences when receiving diagnosis of multiple sclerosis: A qualitative systematic review

BACKGROUND

Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged. The complex and unpredictable nature of MS disease makes the diagnosis process more difficult for the patient. The aim of this study was to review the lived experiences of patients with multiple sclerosis when receiving the diagnosis.

METHODS

We followed the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. A systematic search was performed using four databases including PubMed, Scopus, Web of Science, and psych info on April 2022.

RESULTS

We found 537 articles. After Applying relevant exclusion criteria removing duplicate and irrelevant articles, 13 studies were included in our systematic review after the abstract and full-text screening. Our findings collected data from 10 sub-themes in the following 3 themes to capture patients' experiences after receiving the diagnosis. These included: Emotional reactions to receiving the diagnosis; Communication with health professionals and knowledge about MS and Fear of being different.

CONCLUSION

It is important to understand patients' experiences with the disease and identifying problems to help and support families, patients, and health care personnel's. Therefore, it is necessary to design or implement therapeutic interventions for patients at the time of receiving the diagnosis to reduce psychological problems.

Diagnosis concealment is prevalent in MS, and associated with diagnosis experience

BACKGROUND

Receiving a diagnosis of multiple sclerosis (MS) can be stressful; later, patients may conceal their diagnosis. Here, we aimed to (1) assess prevalence of disclosure and concealment behaviors, and (2) explore whether diagnosis experience is associated with later concealment and if MS provider engagement on this topic modifies concealment.

METHODS

In a survey-based study, MS patients completed DISCO-MS assessing disclosure and concealment and responded to questions about diagnosis experience and practitioner attention to disclosure. Frequency analysis and Pearson's correlations were used in exploratory analyses.

RESULTS

428 adults with MS participated. 49% (N = 201) conceal their diagnosis. Higher education [t(405) = 3.66, p < 0.001], younger age (r = -0.15, p = 0.002), and shorter disease duration (r = -0.18, p = 0.010) were associated with higher concealment. 39% (N = 159) anticipate negative consequences of disclosure. Individuals reporting positive diagnosis experience (26%, N = 102) were less likely to conceal later in disease course compared to those with negative experience (34%, N = 136) [t(233) = 2.483, p = 0.014]. Patients whose MS providers discussed disclosure (23%, N = 73) anticipated less negative consequences of disclosure [t(323) = 2.475, p = 0.014].

CONCLUSIONS

Diagnosis concealment is common in MS. Favorable diagnosis experience and provider attention to the topic of disclosure throughout the MS disease course may influence diagnosis concealment.

Diagnosis concealment is associated with psychosocial outcomes in persons with multiple sclerosis

Persons with multiple sclerosis (pwMS) frequently conceal their diagnosis, fearing professional and personal repercussions of disclosing. Associations of concealment behavior and expected consequences of disclosure with psychosocial outcomes were examined in 90 pwMS who completed validated self-report measures of diagnosis concealment, loneliness, social support, and self-efficacy. More frequent concealment was related to worse loneliness (r_p = 0.213, p = 0.045) and lower social support (r_p = -0.211, p = 0.047), controlling for depression. Higher anticipated negative consequences of disclosure were associated with worse loneliness (r_p = 0.263, p = 0.013), lower social support (r_p = -0.338, p < 0.001), and lower self-efficacy (r_p = -0.350, p < 0.001). Findings hold implications for the development of psychological support strategies addressing concealment/disclosure issues and their psychosocial consequences.