title: Navigating the "liberation procedure": a qualitative study of motivating and hesitating factors among people with multiple sclerosis.
abstract: BACKGROUND
  The debate within the multiple sclerosis (MS) community initiated by the chronic cerebrospinal venous insufficiency (CCSVI) hypothesis and the subsequent liberation procedure placed some people with MS at odds with health care professionals and researchers.
  
  
  OBJECTIVE
  This study explored decision making regarding the controversial liberation procedure among people with MS.
  
  
  METHODS
  Fifteen people with MS (procedure, n=7; no procedure, n=8) participated in audiotaped semistructured interviews exploring their thoughts and experiences related to the liberation procedure. Data were transcribed and analyzed using an iterative, consensus-based, thematic content-analysis approach.
  
  
  RESULTS
  Participants described an imbalance of motivating factors affirming the procedure compared to hesitating factors that provoked the participant to pause or reconsider when deciding to undergo the procedure. Collegial conversational relationships with trusted sources (eg, MS nurse, neurologist) and ability to critically analyze the CCSVI hypothesis were key hesitating factors. Fundraising, family enthusiasm, and the ease of navigation provided by medical tourism companies helped eliminate barriers to the procedure.
  
  
  CONCLUSIONS
  Knowledge of factors that helped to popularize the liberation procedure in Canada may inform shared decision making concerning this and future controversies in MS.
authors.affiliation: Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John's, NL, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ploughman
authors.affiliation: Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John's, NL, Canada.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Harris
authors.affiliation: Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John's, NL, Canada.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Hogan
authors.affiliation: School of Nursing, Memorial University, St John's, NL, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Murray
authors.affiliation: Coalition of Persons with Disabilities, Memorial University, St John's, NL, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Murdoch
authors.affiliation: Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John's, NL, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Austin
authors.affiliation: Department of Neurology, Faculty of Medicine, Memorial University, St John's, NL, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Stefanelli
keywords: CCSVI; alternative medicine; decision making; liberation; multiple sclerosis; qualitative