Evidence suggests that healthcare providers specializing in MS (HCP-MS) face an evolving treatment and clinical landscape, with a patient population who requires advanced care to manage the many facets of their condition. In this context, the gaps in knowledge, skill and confidence that may impact HCP-MS’ ability to make clinical decisions and optimize patient care need to be assessed.
To assess HCP-MS’ clinical practice gaps and challenges, their associated causes, and impact on the care of people with MS.
In a mixed-methods study, 333 neurologists and 135 advanced practice nurses in Canada, France, Germany, Italy, Spain, the United Kingdom and the United States were interviewed or surveyed. Qualitative data were analysed thematically. Quantitative data were analysed using ANOVA and Chi-squares for comparison by country, years of experience, practice setting and MS certification status. Results were triangulated with data from the literature.
Qualitative data indicate current guidelines are perceived as insufficient to manage the complex needs of people with MS. Tests of cognitive function are perceived as time-consuming, potentially inaccurate, and should preferably be administered by rehabilitation specialists or psychiatrists. Survey data indicate 42% of neurologists and 61% of nurses have no or only basic skills in administering such tests. A further 44% and 67%, respectively, have no/basic skills interpreting these tests. HCP-MS reported additional factors that may impede clinical decision-making for optimal personalized care. Thirty-nine percent of neurologists (higher in the UK, Canada and Italy, p<.05) and 44% of nurses report no/basic skills integrating patient goals into treatment recommendations. No/basic skills to make decisions about disease modifying treatment (DMT) sequencing was reported by 28% of neurologists and 62% of nurses. Some adverse events were considered challenging: HCP-MS reported no/basic skills identifying (51%) and managing (61%) infections, and no/basic skills identifying (47%) and managing (56%) cardiac issues.
HCP-MS face significant challenges trying to provide best care to people with MS. There appears to be a need to improve skills in cognitive testing, DMT decision-making, treatment monitoring, and patient communication. Professional development activities should focus on the heterogeneity of MS presentations and optimize different competencies required.
Disclosure: This project has been supported by educational funds from Merck KGaA, Darmstadt, Germany.