Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada.
PLoS One. 2021 Dec 8;16(12):e0261050. doi: 10.1371/journal.pone.0261050. eCollection 2021.
Nurse practitioners (NPs) play a critical role in the multidisciplinary management of patients with multiple sclerosis (MS). Neurologists´ behavioral characteristics have been associated with suboptimal clinical decisions. However, limited information is available on their impact among NPs involved in MS care. The aim of this study was to assess nurses´ therapeutic choices to understand behavioral factors influencing their decision making process.
A non-interventional, cross-sectional, web-based study was conducted. NPs actively involved in the care of patients with MS were invited to participate in the study by the Spanish Society of Neurology Nursing. Participants answered questions regarding their standard practice and therapeutic management of seven simulated relapsing-remitting MS (RRMS) case scenarios. A behavioral battery was used to measure participants´ life satisfaction, mood, positive social behaviors, feeling of helpfulness, attitudes toward adoption of evidence-based innovations, occupational burnout, and healthcare-related regret. The outcome of interest was therapeutic inertia (TI), defined as the lack of treatment escalation when there is clinical and radiological evidence of disease activity. A score to quantify TI was created based on the number of simulated scenarios where treatment intensification was warranted.
Overall, 331 NPs were invited to participate, 130 initiated the study, and 96 (29%) completed the study. The mean age (SD) was 44.6 (9.8) years and 91.7% were female. Seventy-three participants (76.0%) felt their opinions had a significant influence on neurologists´ therapeutic decisions. Sixteen NPs (16.5%) showed severe emotional exhaustion related to work and 13 (13.5%) had depressive symptoms. The mean (SD) TI score was 0.97 (1.1). Fifty-six of NPs showed TI in at least one case scenario. Higher years of nursing experience (p = 0.014), feeling of helpfulness (p = 0.014), positive attitudes toward innovations (p = 0.046), and a higher intensity of care-related regret (p = 0.021) were associated with a lower risk of TI (adjusted R2 = 0.28). Burnout was associated with higher risk of TI (p = 0.001).
Although NPs cannot prescribe MS treatments in Spain, their behavioral characteristics may influence the management of patients with RRMS. Continuing education and specific strategies for reducing occupational burnout may lead to better management skills and improve MS care.
护士从业者（NPs）在多发性硬化症（MS）患者的多学科管理中发挥着关键作用。神经病学家的行为特征与不理想的临床决策有关。然而，关于参与 MS 护理的 NPs 的影响，信息有限。本研究的目的是评估护士的治疗选择，以了解影响其决策过程的行为因素。
这是一项非干预性、横断面、基于网络的研究。西班牙神经病学护理学会邀请积极参与 MS 患者护理的 NPs 参加研究。参与者回答了关于他们在七个模拟复发性缓解型 MS（RRMS）病例情景下的标准实践和治疗管理的问题。使用行为电池来衡量参与者的生活满意度、情绪、积极的社会行为、乐于助人的感觉、对采用基于证据的创新的态度、职业倦怠和与医疗保健相关的遗憾。关注的结果是治疗惰性（TI），定义为在有临床和影像学疾病活动证据的情况下缺乏治疗升级。根据需要强化治疗的模拟情景数量，创建了一个量化 TI 的评分。
共有 331 名 NPs 受邀参加，130 名开始研究，96 名（29%）完成了研究。平均年龄（标准差）为 44.6（9.8）岁，91.7%为女性。73 名参与者（76.0%）认为他们的意见对神经病学家的治疗决策有重大影响。16 名护士（16.5%）表现出与工作相关的严重情绪疲惫，13 名（13.5%）有抑郁症状。平均（标准差）TI 评分为 0.97（1.1）。56 名护士在至少一个病例情景中表现出 TI。较高的护理经验年限（p = 0.014）、乐于助人的感觉（p = 0.014）、对创新的积极态度（p = 0.046）和更高强度的与护理相关的遗憾（p = 0.021）与 TI 风险较低相关（调整后的 R2 = 0.28）。倦怠与 TI 风险增加相关（p = 0.001）。
尽管西班牙的 NPs 不能开 MS 治疗药物，但他们的行为特征可能会影响 RRMS 患者的管理。继续教育和特定的减少职业倦怠策略可能会导致更好的管理技能，并改善 MS 护理。
