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Title: Effect of risk propensity on treatment understanding and decisions in MS patients
Author: Donnachie, Elizabeth
ISNI:       0000 0004 8500 8844
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2019
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Multiple Sclerosis (MS), a leading cause of neurodisability, is a chronic inflammatory disorder of the central nervous system (Thompson, Baranzini, Geurts, Hemmer, & Ciccarelli, 2018). The condition causes changes including sensation, mobility, balance, sphincter, vision and cognition symptoms (Brownlee, Hardy, Fazekas, & Miller, 2017). Although there is no cure for MS, disease-modifying drugs (DMDs) can significantly reduce relapse rates and disease progression (Fogarty, Schmitz, Tubridy, Walsh, & Barry, 2016). People with MS face a difficult decision when it comes to weighing up the various costs and benefits of DMDs as the complex risk-benefit profiles are not always correctly interpreted and understood by people with MS (Reen, Silber, & Langdon, 2017a). Additional support may be required when making decisions in these situations as people with MS have been shown to make different decisions in the context of risk (Sepulveda et al., 2017). Under explicit risk conditions, MS patients show greater risk aversion and deficits on tasks which probe the anticipated effects of decision outcomes on future choices (Simioni et al., 2012). This study highlighted that the quality of decision-making under risk was different for MS patients. It is important that patients are able to understand the complex risk and benefit information surrounding DMDs, which include serious and even fatal side effects, so that they are better able to make decisions about their treatment. Shared decision-making as part of a patient-centred approach has been advocated as the pinnacle of patient-centred care (Barry & Edgman-Levitan, 2012); patient understanding is a prerequisite for successful shared decision-making. Shared decision-making is associated with better DMD adherence rates in MS, this is critical as the efficacy of DMDs depends on high levels of adherence (Ben-Zacharia et al., 2018). Reen and colleagues developed a protocol: the Benefit and Risk Information for Medication in Multiple Sclerosis (BRIMMS), in order to improve patients' understanding and certainty about treatment (Reen, Silber, & Langdon, 2017b). The researchers found that the BRIMMS improved patients' understanding and confidence in treatment decisions, compared to standard presentation of treatment information used in the UK. An individual's risk attitude, risk perception and propensity are important factors that may influence the treatment decision-making process. Once the effect of risk attitude, perception and propensity on treatment understanding and decision certainty is known, characteristics of the patients could be determined in advance of the consultation during which the information is presented. The information could be amended to support the shared decision-making process. A recent systematic review looking at methods to investigate patient preferences for treatment identified the influence of risk perception and uncertainty on treatment decisions as neglected research topics (Webb et al., 2018). The primary aim of the Empirical Study was to confirm the finding that BRIMMS is superior to standard presentation in improving patients' understanding scores and increasing patient certainty in decisions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available