Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol

Abstract

Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS).Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: “regret and decision,” “regret and physicians,” and “regret and nurses.” An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports—recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty.Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals.Spanish National Register (SL42129-20/598-E).

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

“…Positive effects of regret were previously reported [ 29 , 30 ]. The perception of a suboptimal choice or evidence of a bad outcome (e.g., life-threatening side effects of a DMT, disability progression, cognitive impairment) may trigger learning from a former mistake and implementation of preventive measures [ 25 , 30 ]. This phenomenon appears to be associated with more cautious vs. automatic choices and recommendations in patient care.…”

“…A score ≥ 27 indicates a high emotional exhaustion. Regret is an emotion experienced when one believes that the current situation would have had a better outcome by choosing a different course of action [ 25 ]. Care-related regret was associated with suboptimal choices by healthcare professionals [ 13 ].…”

Preferences Toward Attributes of Disease-Modifying Therapies: The Role of Nurses in Multiple Sclerosis Care

“…In addition, participants had to answer questions related to sociodemographic and professional practice characteristics, and completed questionnaires to measure nurses' attitude toward the adoption of medical innovations, coping strategies, workplace burnout, and healthcare-related regret. [21][22][23][24] The Evidence-Based Practice Attitude Scale is a high-psychometric-quality instrument used to measure attitudes toward adopting new treatments, interventions, and practices among healthcare providers. 21 It consists of 15 items rated on a 5-point Likert-type scale, ranging from 0 (not at all) to 4 (to a very great extent).…”

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

“… 1 Regret is a negative emotion experienced when one believes that the current situation would have had a better outcome by choosing a different course of action. 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 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.…”