Background Guiding Framework Results Conclusions Purpose Methods Treatment fatigue has established its presence as a real phenomenon by becoming a mechanism to rationalize and define apparent chasm between treatment adherence and treatment compliance for patients with MS. Incorporating an interpersonal aspect into the compliance and adherence of available treatment alternatives lays a foundation to help healthcare providers best address the combined pathological and psychological impact of treatment fatigue. MS nurses play a key role in fostering patient adherence to treatments and therapy in clinical practice by advocating for, educating, supporting, and encouraging MS patients and their families through their treatment regimen. Background Guiding Framework Results Conclusions Author / Year Aim / Purpose Sample Design Concepts Measured Main Findings / Themes Gaps in knowledge Asano & Finlayson (2014) Summarization of literature about three types of fatigue management: exercise, education, and medication to provide comprehensive perspective on treatment options 25 trials targeting fatigue – selected Meta-analysis Exercise, education, and medication Rehabilitation interventions have a stronger and more significant effect on reducing the impact of patient-reported fatigue than that of education and pharmacological options.   Certain groups benefit from exercise. Exercise interventions with older groups of patients or those with RR/PP and/or severe disability are unknown. Extensive literature review, focus only on exercise, education, and medication to manage fatigue. Coyle, et al (2014) Objective measure of drug therapy compliance N=2966; avg age 49years Observational Study TOP MS TO MS data – digs deep into QoL attributes for MS patients Comparing things that can’t be measured. No correlation between specialty pharmacy and QoL attributes. Crawford, Jewell, Mara, McCatty, & Pelfrey (2014) Factors that lead to treatment fatigue in MS patients. Role of the nurse N/A Review Factors that lead to treatment fatigue, role of MS nurse, and management of treatment fatigue Too subjective – not enough empirical data/justification. Macro measures used – disconnect between what needs to be done Lugaresi, Rottoli, & Patti (2014) Adherence definition and prevalence in MS Expert Review MS-related barriers to adherence - Treatment fatigue, fostering adherence, role of MS nurse Shahrbanian, Duquette, Ahmed, & Mayo (2016) Estimate the extent to which fatigue and other MS symptoms predict participation in the MS patient N=188 Cross-sectional study Self-report; performance-based Fatigue, physical function and psychosocial variables most important direct contributions for participation. More investigation on fatigue due to its overall effect on participation. Tur (2016) Fatigue management in MS Journal article only Clinical aspects of MS fatigue Fatigue Management Scales Interventions (pharm/non-pharm) Article limited to fatigue management including pharmacological and non-pharmacological approaches. Wijenberg, Stapert, Kohler, & Bol (2015) Explaining fatigue in MS N=218 Women – 65 Men – 53, avg age 48 yrs. Hybrid study EDSS; SF36; AFQ Direct correlations between depression and fatigue The cross-sectional study limited to general fatigue – impossible to draw conclusions about casualty and temporal relations in the disease process. All data were self-reported. Suggested that AFQ lacks precision at individual patient level. MS is a complicated disease currently managed primarily by parenterally administered DMTs and additional symptomatic therapies treatment adherence is extremely challenging for this population². treatment fatigue influences a patient’s ability to maintain compliance and adherence with therapy diagnosing treatment fatigue symptoms is challenging behavioral cognitive distortions may, or may not, be directly related to MS MS nurses are best positioned to bridge the gap in this complex arena Fatigue is the most common multiple sclerosis (MS) symptom and occurs in approximately 80% of patients¹. Fatigue affects one’s quality of life and ultimately can contribute to one’s lack of treatment adherence. Purpose There is a gap in the literature that specifies whether treatment fatigue is a barrier to therapy adherence in the MS patient nursing interventions for treatment fatigue that can be fostered by the MS nurse and the patient to promote adherence. Purpose examine how treatment fatigue impacts adherence in the MS patient and specific interventions related to treatment fatigue that can be incorporated by nurses to promote adherence to therapy. Systems Model. Original diagram. (Copyright ©1970 by Betty Neuman) Methods Limitations Themes Fostering adherence to therapy Limited studies found on fatigue associated with treatment adherence Data retrieved is logical and informative, yet too insignificant and unquantifiable to draw any meaningful conclusions on how to best validate the information Implication: Future research is imperative surrounding the topic of treatment fatigue, the impact it has on treatment adherence and compliance, and the non-pharmacological aspects of treating MS. DePaul University Richardson Library Keywords: “multiple sclerosis”, “fatigue”, adherence OR compliance”, “nursing interventions”, “scales OR instruments”, “quality of life”, “evidence based practice” Inclusion Criteria: peer-reviewed, English language, published between 2012-2017, men and women Exclusion Criteria: none # of studies found using keywords CINAHL N=7 PsychInfo N=20 ProQuest N=45 PubMed N=9 # of studies meeting inclusion criteria 5 20 45 9 # of studies after excluding duplicates 35 3 # of studies after using exclusion criteria 4 7 1 # of studies selected based on total content 17 Treatment fatigue is a real phenomenon Effects of fatigue on adherence Research Questions Does treatment fatigue impact treatment adherence in MS patient? How does treatment fatigue impact treatment adherence in MS? What are specific interventions related to treatment fatigue that can be incorporated by MS patients to promote treatment adherence? References 1 National Multiple Sclerosis Society. MS symptoms: More common symptoms. www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms. 2. Costello, K., Kennedy, P., Scanzillo, J. Recognizing nonadherence in patients with multiple sclerosis and maintaining treatment adherence in the long term. The Medscape Journal of Nursing, 2008; 10(9).