Perceived Quality of Treatment Decisions and Determinants of Decisional Conflict in Early-Stage Relapsing–Remitting Multiple Sclerosis

INTRODUCTION: Selecting a disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS) is a preference-sensitive decision where shared decision-making (SDM) is essential. This study aimed to evaluate the perceived quality of the SDM process and identify independent determinants of decisional conflict among patients with early-stage RRMS. METHODS: This non-interventional, cross-sectional, multicenter study across 16 Spanish neuroimmunology clinics evaluated adults with early RRMS (≤ 3 years disease duration from diagnosis) receiving DMTs. SDM process quality and decisional conflict were assessed using the AGA-25 questionnaire and the SURE tests, respectively. Multivariable logistic regression models were constructed to identify independent determinants of high process satisfaction and decisional conflict. RESULTS: The evaluable population comprised 145 patients (mean age 37.6 years, 69.0% female). Participants evaluated the SDM process favorably (mean total AGA-25 score 67.1 [SD 9.1]). High process satisfaction was reported by 26.2% of patients (n = 38). In multivariable analysis, male sex and a higher total number of relapses since disease onset were associated with significantly lower odds of high process satisfaction, whereas higher decisional certainty was an independent positive determinant. Clinically significant decisional conflict was present in 27.1% of participants (n = 36). In the multivariable model, greater illness-related uncertainty, a more threatening illness perception, and higher fatigue impact independently increased the likelihood of decisional conflict. CONCLUSION: Although patients with early-stage RRMS generally report a favorable overall perception of collaborative treatment selection, high process satisfaction is attained by only approximately one-quarter of patients. Furthermore, clinically significant decisional conflict affects over 27% of individuals early in their disease course. This decisional distress is driven predominantly by the subjective emotional and perceptual burden of living with MS, rather than objective physical disability.