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Saposnik G, Sempere AP, Prefasi D, et al. Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS). Front Neurol. 2017;8:65doi: 10.3389/fneur.2017.00065.
Saposnik, G., Sempere, A. P., Prefasi, D., Selchen, D., Ruff, C. C., Maurino, J., & Tobler, P. N. (2017). Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS). Frontiers in neurology, 865. https://doi.org/10.3389/fneur.2017.00065
Saposnik, Gustavo, et al. "Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS)." Frontiers in neurology vol. 8 (2017): 65. doi: https://doi.org/10.3389/fneur.2017.00065
Saposnik G, Sempere AP, Prefasi D, Selchen D, Ruff CC, Maurino J, Tobler PN. Decision-making in Multiple Sclerosis: The Role of Aversion to Ambiguity for Therapeutic Inertia among Neurologists (DIScUTIR MS). Front Neurol. 2017 Mar 01;8:65. doi: 10.3389/fneur.2017.00065. eCollection 2017. PMID: 28298899; PMCID: PMC5331032.
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Front Neurol. 2017 Mar 01;8:65. doi: 10.3389/fneur.2017.00065. eCollection 2017.

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

Frontiers in neurology

Gustavo Saposnik, Angel P Sempere, Daniel Prefasi, Daniel Selchen, Christian C Ruff, Jorge Maurino, Philippe N Tobler

Affiliations

  1. Division of Neurology, Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
  2. Department of Neurology, Hospital General Universitario de Alicante , Alicante , Spain.
  3. Neuroscience Area, Medical Department, Roche Farma , Madrid , Spain.
  4. Division of Neurology, Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto , Toronto, ON , Canada.
  5. Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich , Zurich , Switzerland.

PMID: 28298899 PMCID: PMC5331032 DOI: 10.3389/fneur.2017.00065

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;

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: decision-making; disease-modifying therapy; multiple sclerosis; neuroeconomics; risk aversion

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