Behavioral aspects of nurse practitioners associated with optimal multiple sclerosis care in Spain

Abstract

Background Nurse practitioners (NPs) play a critical role in the multidisciplinary management of patients with multiple sclerosis (MS). Neurologists´ behavioral characteristics have been associated with suboptimal clinical decisions. However, limited information is available on their impact among NPs involved in MS care. The aim of this study was to assess nurses´ therapeutic choices to understand behavioral factors influencing their decision making process. Methods A non-interventional, cross-sectional, web-based study was conducted. NPs actively involved in the care of patients with MS were invited to participate in the study by the Spanish Society of Neurology Nursing. Participants answered questions regarding their standard practice and therapeutic management of seven simulated relapsing-remitting MS (RRMS) case scenarios. A behavioral battery was used to measure participants´ life satisfaction, mood, positive social behaviors, feeling of helpfulness, attitudes toward adoption of evidence-based innovations, occupational burnout, and healthcare-related regret. The outcome of interest was therapeutic inertia (TI), defined as the lack of treatment escalation when there is clinical and radiological evidence of disease activity. A score to quantify TI was created based on the number of simulated scenarios where treatment intensification was warranted. Results Overall, 331 NPs were invited to participate, 130 initiated the study, and 96 (29%) completed the study. The mean age (SD) was 44.6 (9.8) years and 91.7% were female. Seventy-three participants (76.0%) felt their opinions had a significant influence on neurologists´ therapeutic decisions. Sixteen NPs (16.5%) showed severe emotional exhaustion related to work and 13 (13.5%) had depressive symptoms. The mean (SD) TI score was 0.97 (1.1). Fifty-six of NPs showed TI in at least one case scenario. Higher years of nursing experience (p = 0.014), feeling of helpfulness (p = 0.014), positive attitudes toward innovations (p = 0.046), and a higher intensity of care-related regret (p = 0.021) were associated with a lower risk of TI (adjusted R2 = 0.28). Burnout was associated with higher risk of TI (p = 0.001). Conclusions Although NPs cannot prescribe MS treatments in Spain, their behavioral characteristics may influence the management of patients with RRMS. Continuing education and specific strategies for reducing occupational burnout may lead to better management skills and improve MS care.

Assessing care-related regret among nurses specialized in multiple sclerosis: A psychometric analysis of a new assessment battery

“…Nurses play an essential role in the care of MS patients, but are usually exposed to a high care burden that can lead to suboptimal therapeutic choices, regret, and burnout. 2,4,10 Identifying regret among nurses may be critical for implementing specific strategies to maintain an adequate functioning of MS care units. 2 The assessment of regret has been carried out using qualitative and quantitative methods.…”

“… 2 The experience of regret in the context of patient care is a common phenomenon that may lead to suboptimal medical decisions and negative health consequences for physicians and nurses. 2 – 4 Back pain, sleep problems, poor quality of life, low job satisfaction, absenteeism, and high staff turnover have been reported among nurses experiencing care-related regret. 2 The current multiple sclerosis (MS) management landscape is a common ground for the emergence of regretful experiences due to the uncertain disease trajectory and different treatment options with complicated safety risk profiles.…”

Therapeutic Decision-Making Under Uncertainty in the Management of Spinal Muscular Atrophy: Results From DECISIONS-SMA Study

“…The primary outcome of interest was therapeutic inertia (TI), defined as the absence of treatment initiation or intensification when treatment goals are unmet [ 17 ]. As in our previous research, we created a TI score to represent the number of case scenarios where treatment initiation or escalation was warranted over the 11 presented case scenarios [ 18 , 19 ]. This score may range from 0 to 11, where higher values represent a higher degree of TI.…”

“…We applied concepts from behavioral economics that were previously associated with suboptimal therapeutic decisions or TI [ 18 , 19 , 25 ]. Physicians’ tolerance to uncertainty was assessed using the standardized physician’s reaction to an uncertainty test [ 26 , 27 ].…”

The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis

“…• PwMS perceive spasticity as one of the most limiting symptoms for activities of daily living (ADL) and is associated with a worse perception of quality of life (QoL). (Fernández-Pablos et al, 2016;Saposnik et al, 2021). Importantly, they can capture the perception of their symptoms more closely.…”