Integrating a newly developed cognitive screening and management pathway within MS clinics in the United Kingdom: A qualitative study

Abstract

Introduction: Currently in the United Kingdom, there is no routine screening for cognitive problems and sufficient provision of neuropsychological management for all people with Multiple Sclerosis (pwMS) with cognitive problems. The NEuRoMS programme (www.neuroms.org) developed a pathway for routine cognitive screening (with >3,000 already screened) and a brief cognitive rehabilitation intervention programme for mild cognitive problems in pwMS. Objectives/Aims: This study investigated how the cognitive screening pathway was integrated into routine clinical practice in MS clinics, and how the intervention was experienced by those who delivered and received it. Method(s): Multi-centre, in-depth qualitative case study across three NHS Trusts. Semi-structured interviews were conducted with 28 people: 8 pwMS with mild cognitive problems who received the cognitive screening and NEuRoMS intervention, 5 related informants, 12 clinicians (four per site), and 3 intervention providers (one per site). Interview data, transcribed verbatim and analysed using Framework Analysis, were mapped to thematic matrices of the programme theory for the screening pathway and intervention. Result(s): Overall, pwMS were able to complete screening online at home without any support. Clinicians expressed support for the pathway, indicating that it provided a clear structure to both identifying and managing cognitive problems for pwMS. However, implementation of the pathway also highlighted service gaps such as time constraints during appointments to discuss the screening results and the paucity of referral pathways to specialist psychology services. Overall, the integration of the pathway worked well within existing IT systems in the services, with processes put in place to ensure the screening results could be accessed by the clinicians. PwMS reported increased awareness of their cognitive abilities and limitations, and an increase in use of compensatory strategies following the intervention. Intervention providers identified that more time should be spent on the goal setting components of the intervention during sessions. Conclusion(s): The screening and management pathway has been revised based on recommendations from key stakeholders. The changes that have been implemented include considering those with mild and moderate cognitive problems for the NEuRoMS intervention, and modifying the intervention delivery to focus more on the goal-setting components.