Changing the Multiple Sclerosis Diagnostic Pathway: Insights From Stakeholders on Implementing Novel Radiological Biomarkers

Background: The multiple sclerosis (MS) diagnostic process can be lengthy and result in psychological distress and treatment delays. The 2024 revised McDonald diagnostic criteria incorporate the central vein sign (CVS) and paramagnetic rim lesions (PRL), radiological biomarkers that offer the potential to improve the diagnostic pathway. Methods: The study aims were to: (1) investigate the experiences of people with MS and health care professionals (HCPs) regarding the current diagnostic process, and (2) identify the barriers and facilitators to implementing the revised diagnostic criteria. Semistructured individual interviews and focus groups were conducted with 10 HCPs and 9 people with MS. Framework analysis, applying normalization process theory, was employed. Results: Interviews revealed 4 themes: current challenges for the diagnostic pathway, CVS/PRL implementation barriers, the benefits of CVS/PRL implementation, and suggestions for overcoming implementation barriers and improving the diagnostic pathway. Challenges to implementation include pathway inefficiencies, care delivery inequality, insufficient communication, financial constraints, capacity limitations, and clinician hesitancy with the revised criteria. Suggested strategies for implementation and improvement included HCP training, enhancing interdisciplinary collaboration, evaluating implemented changes, and delivering emotional and practical support during diagnosis. Benefits for CVS/PRL implementation included reduced reliance on lumbar punctures, improved patient experience, cost-effectiveness, and enhanced diagnostic accuracy. Conclusions: Despite patient enthusiasm, implementing the revised diagnostic criteria will be challenging and possibly delayed unless HCP concerns are appropriately addressed.