Saposnik Gustavo, Sempere Angel P, Prefasi Daniel, Selchen Daniel, Ruff Christian C, Maurino Jorge, Tobler Philippe N
Division of Neurology, Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Department of Neurology, Hospital General Universitario de Alicante , Alicante , Spain.
Front Neurol. 2017 Mar 1;8:65. doi: 10.3389/fneur.2017.00065. eCollection 2017.
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.
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.
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; = 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).
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.
关于影响多发性硬化症（MS）治疗惰性（TI）的医生相关因素的信息有限。我们的目的是通过应用行为经济学的概念，评估医生的风险偏好是否与MS护理中的TI相关。
在这项横断面研究中，参与者回答了有关20个MS病例场景管理的问题，完成了3项调查和4个基于行为经济学的实验范式。调查和实验包括金融和健康领域中对模糊性厌恶的标准化测量、医生对患者护理中不确定性的反应以及与不同领域风险偏好相关的问题。主要结果是当医生基于临床（新的复发）和磁共振成像活动需要升级治疗而患者正在使用疾病修饰药物时的TI。
在被邀请参与该项目的161名神经科医生中，136名与研究合作（合作率84.5%），96名完成了调查（回复率：60%）。68.8%的参与者存在TI。基于改良的里约热内卢或临床进展对TI的定义也观察到了类似结果。对模糊性的厌恶与TI的较高患病率相关（对模糊性高度厌恶的为86.4%，对模糊性较低或无厌恶的为63.5%；P = 0.042）。在多变量分析中，对模糊性的高度厌恶是TI的最强预测因素（OR 7.39；95%CI 1.40 - 38.9），其次是对不确定性的低耐受性（OR 3.47；95%CI 1.18 - 10.2）。
TI是一种常见现象，影响着近十分之七照顾MS患者的医生。TI的较高患病率与医生对模糊性的强烈厌恶和对不确定性的低耐受性相关。
