Abstract
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; p = 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.
Highlights
Making decisions in medical care is a complex task [1]
In order to evaluate the consistency of the relationship with the primary outcome, we analyzed another definition of ambiguity aversion
Out of the 161 neurologists who were invited to participate in the study from representative areas of Spain, 136 cooperated and 96 completed the survey
Summary
Making decisions in medical care is a complex task [1]. Physicians have limited education in both risk management and decisionmaking at medical schools [2]. Uncertainty is a generic term that comprises risk and ambiguity. Risk applies to events with known probability [3]. Ambiguity is a term reserved for events for which probabilities are unknown [3]. People are averse to both ambiguity and risk, and the two aversions are independent of each other [4]. Uncertainty is one of the most important contributing factors affecting decisions in medical care [5, 6]. Limited information is available regarding the role of aversion to ambiguity in medical decisions
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call