Kvaliteta partnerskega odnosa in spolna disfunkcija pri bolnikih z multiplo sklerozo v povezavi z zadovoljstvom z zdravljenjem z imunomodulatornim zdravilom : doktorska desertacija

slovenian

doktorska dela

2022

immunomodulatory treatment   multiple sclerosis   partner relationship   sexual dysfunction

Univerza v Ljubljani, Teološka fakulteta
(Obvezni izvod spletne publikacije)

Multiple sclerosis is chronic inflammatory disease with presumed autoimmune ethology which typically occurs during the most productive period of life. It mostly affects people between 20 and 40 years old and has 2-4 times greater incidence in women. This is also a period in life when a person looks for a partner, establish a family and is usually also at the top of professional carrier. Multiple sclerosis has thereby strong influence of partner relationship and family life as such. Symptoms, possible side effects of medical treatment, psychological, social and cultural issues may influence sexual activity which represents very important component of partner relationship. Since there are, to our knowledge, no studies investigating relationship between satisfaction with multiple sclerosis treatment, partner relationship and sexual dysfunction, we addressed this topic which is even more important in view of long-term immunomodulatory treatment with significant side effects influencing every day quality of life. Our study is divided into the three parts. We initially addressed marital status of patients with multiple sclerosis on immunomodulatory treatment and determined the proportions of patients who were in either partner relationship, divorced or single. We then investigated possible relationship between satisfaction with multiple sclerosis treatment, quality of partner relationship and sexual dysfunction considering the degree of neurological disability and duration of the disease. We further investigated if patients with more simple treatment including tablets and infusions were more satisfied, have better partner relationship and less frequent sexual dysfunction compared to patients with more complex treatment including administration of the drug by subcutaneous/intramuscular injections. The third part of our study was qualitative and aimed to complement quantitative research. We included 588 patients and use three questionnaires: Treatment Satisfaction Questionnaire for Medication – TSQM, Dyadic adjustment scale – DAS and Multiple Sclerosis Intimacy and Sexuality Questionnaire – MSISQ-19. We found that majority of patients with multiple sclerosis on immunomodulatory treatment were married or had extramarital relationship. Patients receiving more simple treatment with tablets and infusions were more satisfied compared to patients on subcutaneous/intramuscular injections. More simple treatment was associated also with less secondary and tertiary dysfunction. There was, however, no association between mode of treatment and quality of partner relationship. Herein presented qualitative analysis was based on grounded theory. We exposed important aspects of life in patients with multiple sclerosis who are in partner relationship. We established 5 categories including partner relationship, spare time, disease and treatment, changes in physical status and sexuality. We developed a model »MS TODAY« aimed to facilitate treatment of patients in centres for multiple sclerosis. This would enable more comprehensive view on patient life with multiple sclerosis, tolerance of immunomodulatory treatment, partner relationship and social as well as economic status.Our results are expected to contribute new evidence which will facilitate target interventions in relationship and family therapy in patients with multiple sclerosis.

23.05.2023