title: Clinical decision-making in multiple sclerosis: Challenges reported internationally with emerging treatment complexity.
abstract: BACKGROUND
  The introduction of several new disease-modifying therapies (DMTs) to the field of Multiple Sclerosis (MS) treatment requires that MS healthcare providers have a comprehensive understanding of the implications of each new treatment option in order to select the treatment that best suits their patient. An international study was conducted in 6 countries to obtain a better understanding of the issues and challenges experienced by Neurologists and Nurses in the treatment and management of their patients with MS. The goal of this research was to obtain evidence to inform future Continuing Medical Education (CME) initiatives and health policies that promote knowledge translation to clinical practice. This article focuses on challenges reported in relation to the use of newly approved therapies, in light of the risks of these new treatments, as well as screening and monitoring precautions that must be taken.
  
  
  METHODS
  An exploratory study and literature review informed the design of an IRB-approved online survey deployed to MS Neurologists and Nurses practicing in 6 countries (Germany, France, Italy, Spain, UK, USA).
  
  
  RESULTS
  The sample consisted of actively practicing Neurologists (n=156) and Nurses (n=153). Substantive challenges were reported in participant's knowledge of and confidence in three categories: i) safety profile of newly approved therapies, ii) screening patients for treatment with newly approved therapies, and iii) monitoring for serious adverse events.
  
  
  CONCLUSIONS
  Findings indicate that, internationally, healthcare providers report substantive challenges integrating newly approved therapies into their clinical decision-making. This study highlights potential factors underlying the challenges, and identifies important targets for CME interventions and policymakers to enhance clinical decision-making amongst MS providers.
authors.affiliation: AXDEV Group Inc., 210-8, Place du Commerce, Brossard, QC, Canada J4W 3H2. Electronic address: ngp@axdevgroup.com.
authors.forename: Pamela
authors.initials: P
authors.lastname: Ng
authors.affiliation: AXDEV Group Inc., 210-8, Place du Commerce, Brossard, QC, Canada J4W 3H2.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Murray
authors.affiliation: AXDEV Group Inc., 210-8, Place du Commerce, Brossard, QC, Canada J4W 3H2.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Hayes
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods; D005602:France; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D038622:Internationality; D007558:Italy; D009103:Multiple Sclerosis / Q000628:therapy*; D009462:Neurology / Q000379:methods; D009726:Nurses / Q000523:psychology; D010820:Physicians / Q000523:psychology; D013030:Spain; D006113:United Kingdom; D014481:United States
keywords: Clinical decision-making; Multiple sclerosis; Needs assessment; Neurologists; Newly approved treatment; Nurses