Cognitive assessment in multiple sclerosis clinical care: a qualitative evaluation of stakeholder perceptions and preferences

There is a growing consensus that cognitive assessments should form part of routine clinical care in Multiple Sclerosis (MS). However, what remains unclear is which assessments are preferred by “stakeholders” (including people with MS, family members, charity volunteers, clinicians, and healthcare commissioners), in which contexts, and in which formats. Therefore, the aim of this study was to collect and synthesise stakeholders’ perceptions of the assessments that are acceptable and feasible for routine administration in the UK healthcare system.We interviewed 44 stakeholders and held one focus group (n=5). We asked stakeholders about their experience with cognitive impairment and assessment, and their views on how cognitive assessment could be implemented within routine clinical care.Using framework analysis, we summarised three themes: the current cognitive screening situation; the suitability of commonly used assessments; and feasibility aspects, including modality and location of testing. All participants acknowledged that cognitive impairment could have a significant impact on quality of life, but assessment and monitoring is not routine. Barriers and enablers were described, and most participants reported that brief, routine screening with tests such as symbol substitution was acceptable. Electronic, self-administration of cognitive screening would be beneficial in minimising clinic attendance and staff time.