The Relationship of Aspects of the Shared Decision Making Process and Vaccination Hesitancy in People with Multiple Sclerosis

Background: Multiple Sclerosis has multiple available disease modifying therapies (DMT) with varied impact on the immune system. The Covid-19 viral pandemic has affected PwMS to varying degrees based on vaccination status, DMT choice and other factors. Effective vaccination has reduced Covid-19 impact but not all people are vaccinated or effectively vaccinated. To accept vaccination or not is a choice that is made by a shared decision making (SDM) process. Understanding the potential impact of this decision relates to future satisfaction from this decision. SDM is a process where the patient, prescribing clinician and/or family members mutually agree on an appropriate treatment choice after discussion of risks and benefits of the relevant and available treatment options. The Control Preferences Scale (CPS) is the most frequently used measure of SDM. The CPS shows patients preferences as Active, Collaborative, or Passive SDM. “Active” denotes that the patients want most of the “say” in treatment decision (A), “collaborative” reflects varying degrees of “say” between practitioner and patient (B, C, D), and “passive” being patients want practitioner to make medical decisions (E). COVID-19 is vaccine hesitancy (VH) is a major hurdle for vaccination. The validated Vaccine 5C scale (V5C) assesses 5 psychological antecedents of vaccination and could be effective in exploring COVID-19 VH in PwMS. Combining the CPS and the V5C might provide further insight to VH barriers in PwMS.

Objectives: To enhance insight into the decision making process how people with Multiple Sclerosis (PwMS) and preferences related to vaccination

Methods: A retrospective chart review of a PwMS registry collected prospectively where the following information was explored: CPS, V5C and demographic information (age, gender, DMT prescribed) at the time this information was obtained in routine care.

Results: N= 202 PwMS (74% female, X̅age = 50.6 ± 11.7 years) Single ANOVA factor and T-tests were used with the following significant differences in V5C question survey answers across CPS-SDM groupings were found (p<0.05): V5C#2 -PwMS CPS-E are undecided about the need for vaccination compared across all other SDM-CPS groups, and for V5C#3 PwMS CPS-E have no opinion if every day stress gets in the way of vaccination where all other SDM-CPS groups have other opinions.

Conclusions: Patient centric SDMT approach individual PwMS prefer directly impacts whether PwMS feel that vaccination is necessary today (V5C-2) as well as whether stress prevents them from getting a vaccination (V5C-3). This information could provide additional opportunities to enhance vaccination acceptance.