Please use this identifier to cite or link to this item: https://hdl.handle.net/11000/30553

Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS)


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Title:
Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS)
Authors:
Saposnik, Gustavo  
Perez-Sempere, Angel  
Prefasi, Daniel  
Selchen, Daniel
Ruff, Christian  
Maurino, Jorge  
Tobler, Philippe  
Editor:
Frontiers Media
Department:
Departamentos de la UMH::Medicina Clínica
Issue Date:
2017-03
URI:
https://hdl.handle.net/11000/30553
Abstract:
Objectives: Limited information is available on physician-related factors influencing therapeutic inertia (TI) in multiple sclerosis (MS). Our aim was to evaluate whether physicians’ risk preferences are associated with TI in MS care, by applying concepts from behavioral economics. Design: In this cross-sectional study, participants answered questions regarding the management of 20 MS case scenarios, completed 3 surveys, and 4 experimental paradigms based on behavioral economics. Surveys and experiments included standardized measures of aversion ambiguity in financial and health domains, physicians’ reactions to uncertainty in patient care, and questions related to risk preferences in different domains. The primary outcome was TI when physicians faced a need for escalating therapy based on clinical (new relapse) and magnetic resonance imaging activity while patients were on a disease-modifying agent. Results: Of 161 neurologists who were invited to participate in the project, 136 cooperated with the study (cooperation rate 84.5%) and 96 completed the survey (response rate: 60%). TI was present in 68.8% of participants. Similar results were observed for definitions of TI based on modified Rio or clinical progression. Aversion to ambiguity was associated with higher prevalence of TI (86.4% with high aversion to ambiguity vs. 63.5% with lower or no aversion to ambiguity; p = 0.042). In multivariate analyses, high aversion to ambiguity was the strongest predictor of TI (OR 7.39; 95%CI 1.40–38.9), followed by low tolerance to uncertainty (OR 3.47; 95%CI 1.18–10.2). Conclusion: TI is a common phenomenon affecting nearly 7 out of 10 physicians caring for MS patients. Higher prevalence of TI was associated with physician’s strong aversion to ambiguity and low tolerance of uncertainty.
Keywords/Subjects:
multiple sclerosis
disease-modifying therapy
neuroeconomics
decision-making
risk aversion
Knowledge area:
CDU: Ciencias aplicadas: Medicina
Type of document:
application/pdf
Access rights:
info:eu-repo/semantics/openAccess
DOI:
https://doi.org/10.3389/fneur.2017.00065
Appears in Collections:
Artículos Medicina Clínica



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