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Decision-making in multiple sclerosis: the role of aversion to ambiguity for therapeutic inertia among neurologists (DIScUTIR MS)


Saposnik, Gustavo; Sempere, Angel P; Prefasi, Daniel; Selchen, Daniel; Ruff, Christian C; Maurino, Jorge; Tobler, Philippe N (2017). Decision-making in multiple sclerosis: the role of aversion to ambiguity for therapeutic inertia among neurologists (DIScUTIR MS). Frontiers in Neurology, 8:65.

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.

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:03 Faculty of Economics > Department of Economics
Dewey Decimal Classification:330 Economics
Uncontrolled Keywords:multiple sclerosis, disease-modifying therapy, neuroeconomics, decision-making, risk aversion
Language:English
Date:March 2017
Deposited On:23 Jan 2018 19:29
Last Modified:19 Feb 2018 10:43
Publisher:Frontiers Research Foundation
ISSN:1664-2295
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.3389/fneur.2017.00065
PubMed ID:28298899

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