title: How Do People with Multiple Sclerosis Experience Prognostic Uncertainty and Prognosis Communication? A Qualitative Study.
abstract: BACKGROUND
  Disease progression in multiple sclerosis (MS) is highly variable and predicting prognosis is notoriously challenging. Patients' prognosis beliefs, responses to prognostic uncertainty and experiences of prognosis-related communication with healthcare professionals (HCPs) have received little study. These issues have implications for patients' psychological adjustment and are important in the context of the recent development of personalised prognosis forecasting tools. This study explored patient perspectives on the experience of prognostic uncertainty, the formation of expectations about personal prognosis and the nature of received and desired prognosis communication.
  
  
  METHODS
  15 MS patients participated in in-depth semi-structured interviews which were analysed using inductive thematic analysis.
  
  
  RESULTS
  Six themes captured key aspects of the data: Experiencing unsatisfactory communication with HCPs, Appreciating and accepting prognostic uncertainty, Trying to stay present-focused, Forming and editing personal prognosis beliefs, Ambivalence towards forecasting the future, and Prognosis information delivery. MS patients report having minimal communication with HCPs about prognosis. Over time MS patients appear to develop expectations about their disease trajectories, but do so with minimal HCP input. Provision of prognosis information by HCPs seems to run counter to patients' attempts to remain present-focused. Patients are often ambivalent about prognosis forecasting and consider it emotionally dangerous and of circumscribed usefulness.
  
  
  CONCLUSIONS
  HCPs must carefully consider whether, when and how to share prognosis information with patients; specific training may be beneficial. Future research should confirm findings about limited HCP-patient communication, distinguish predictors of patients' attitudes towards prognostication and identify circumstances under which prognostic forecasting benefits patients.
authors.affiliation: Academic Unit of Psychology, University of Southampton, Southampton, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Dennison
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Ellen
authors.initials: E
authors.lastname: McCloy Smith
authors.affiliation: Academic Unit of Psychology, University of Southampton, Southampton, United Kingdom.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bradbury
authors.affiliation: Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Galea
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000473:pathology / Q000523:psychology*; D011369:Professional-Patient Relations; D011379:Prognosis; D036301:Qualitative Research; D011795:Surveys and Questionnaires