There’s No Magic Pill: A Multimethods Qualitative Study Exploring Routine Fatigue Care in People With Multiple Sclerosis

BACKGROUND: Fatigue is a common and debilitating symptom for people with multiple sclerosis (MS). Evidence suggests that behavioral treatments, particularly cognitive behavioral therapy and some exercise therapies, are effective in reducing MS fatigue. However, few people are offered these treatments in routine care, and little is known about the reasons for this research-to-practice gap. The aim of this study was to explore how routine care is currently delivered for MS fatigue. METHODS: Health care professionals (n = 28) took part in 6 focus groups and 6 one-to-one interviews exploring experiences with assessing, managing, and treating fatigue. How health care professionals (n = 10) delivered MS fatigue management was observed across 19 patient-clinician consultations in 4 National Health Service clinics in London, the North East, and the South West of England. All data were analyzed using reflexive thematic analysis. RESULTS: Three key themes with subthemes were generated: (1) MS fatigue is not formally screened, (2) promoting self-management for MS fatigue, and (3) MS fatigue cannot be treated in isolation. Key findings included relying on people who have MS to recognize and report their experience of fatigue, the use of the multidisciplinary team to trickle fatigue management through their practice, and the tendency for professionals to sometimes differ in their interpretations of fatigue management advice. CONCLUSIONS: The findings indicate that introducing a formal screening measure and developing a standardized, evidence-based behavioral treatment that can be implemented into routine care may allow for improved treatment of MS fatigue.