title: Understanding Drivers of Employment Changes in a Multiple Sclerosis Population.
abstract: BACKGROUND
  Qualitative data are lacking on decision making and factors surrounding changes in employment for patients with multiple sclerosis (MS). This study aimed to increase our understanding of the key symptoms and factors leading patients with MS to leave work or reduce employment.
  
  
  METHODS
  Adults with MS who reported leaving the workforce, reducing work hours, or changing jobs due to MS in the past 6 months were recruited from four US clinical sites. Patients participated in semistructured interviews to discuss MS symptoms and reasons for changing employment status. All interviews were transcribed and coded for descriptive analyses.
  
  
  RESULTS
  Twenty-seven adults (mean age = 46.3 years, mean duration of MS diagnosis = 10.9 years) with a range of occupations participated; most were white (81.5%) and female (70.4%). Physical symptoms (eg, fatigue, visual deficits) (77.8%) were the most common reasons for employment change; 40.7% of patients reported at least one cognitive symptom (eg, memory loss). Fatigue emerged as the most pervasive symptom and affected physical and mental aspects of patients' jobs. Most patients (85.2%) reported at least two symptoms as drivers for change. Some patients reported a significant negative impact of loss of employment on their mental status, family life, and financial stability.
  
  
  CONCLUSIONS
  Fatigue was the most common symptom associated with the decision to leave work or reduce employment and can lead to a worsening of other MS symptoms. Comprehensive symptom management, especially fatigue management, may help patients preserve their employment status.
authors.affiliation: Evidera, Outcomes Research, Bethesda, MD, USA (KSC, BMC, ASL); and Genzyme, a Sanofi company, Cambridge, MA, USA (ANB, TLW).
authors.forename: Karin S
authors.initials: KS
authors.lastname: Coyne
authors.affiliation: Evidera, Outcomes Research, Bethesda, MD, USA (KSC, BMC, ASL); and Genzyme, a Sanofi company, Cambridge, MA, USA (ANB, TLW).
authors.forename: Audra N
authors.initials: AN
authors.lastname: Boscoe
authors.affiliation: Evidera, Outcomes Research, Bethesda, MD, USA (KSC, BMC, ASL); and Genzyme, a Sanofi company, Cambridge, MA, USA (ANB, TLW).
authors.forename: Brooke M
authors.initials: BM
authors.lastname: Currie
authors.affiliation: Evidera, Outcomes Research, Bethesda, MD, USA (KSC, BMC, ASL); and Genzyme, a Sanofi company, Cambridge, MA, USA (ANB, TLW).
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Landrian
authors.affiliation: Evidera, Outcomes Research, Bethesda, MD, USA (KSC, BMC, ASL); and Genzyme, a Sanofi company, Cambridge, MA, USA (ANB, TLW).
authors.forename: Todd L
authors.initials: TL
authors.lastname: Wandstrat