Directions for advancing prognostic assessments in multiple sclerosis: Qualitative Insights from MS specialist Interviews

Background: Reliable prognostication in multiple sclerosis (MS) is essential for personalized care, yet remains challenging. In the absence of widely implemented prognostic tools, how MS specialists today formulate prognostic judgments and manage related challenges in routine practice is underexplored. Objective: To investigate how MS specialists approach prognostication in practice and identify their priorities for improving prognosis-informed care. Methods: Twelve MS specialists from European and Middle Eastern regions participated in semi-structured interviews. Data were qualitatively analyzed using a two-phase content analysis. Priorities were topics mentioned by more than 50% of participants. Results: Nine priority questions were identified for improving prognosis-informed MS care: 1) What minimal data are needed to estimate prognosis early?, 2) How should prognostic factors be combined and weighted?, 3) How can subclinical progression be detected and addressed?, 4) How can (less experienced) neurologists be better supported?, 5) How should prognosis-based decisions align with reimbursement and patient preferences?, 6) How can clinical intuition be used alongside evidence?, 7) How can prognosis be communicated, supporting patient optimism and empowerment?, 8) How to develop prognostic tools for MS?, 9) How can quality of life be integrated as a core prognostic outcome?. Conclusion: MS prognostication in current practice remains fragmented and experience-driven. Addressing these questions could guide future research and the development of prognostic tools that embed prognosis-informed care into MS management.