{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:16:46Z","timestamp":1747196206033,"version":"3.40.5"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Roche Farma","award":["SL42765"],"award-info":[{"award-number":["SL42765"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The therapeutic landscape for spinal muscular atrophy has changed in the last few years, encompassing respiratory\/motor function and life expectancy benefits. However, physicians still have the challenge of tailoring individuals\u2019 treatment to therapeutic goals, disease progression, patient\/caregiver\u2019s preferences, and personal experience to achieve an optimal risk\/benefit balance. This study aims to provide insight into the preferred treatment choices of pediatric neurologists managing spinal muscular atrophy in their daily practice and to recognize behavioral factors that may influence decision-making.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a noninterventional, cross-sectional pilot study involving 50 pediatric neurologists managing spinal muscular atrophy in Spain. We designed an online platform that contains 13 simulated case scenarios of common presentations of patients with spinal muscular atrophy. The primary study outcome will be treatment preferences according to the percentages of participants who select treatment initiation when recommended, switch therapies when there is evidence of disease progression, and select treatment discontinuation when disease progression puts patients outside treatment recommendation (11 case scenarios). Secondary outcomes include therapeutic inertia prevalence (11 case scenarios), herding phenomenon prevalence (2 case scenarios), care-related regret prevalence (specific questions) and intensity (10-item Regret Intensity Scale), occupational burnout prevalence (nonproprietary single-item measure), and risk preferences (uncertainty test and risk aversion assessment).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The study findings will contribute to better understand relevant factors associated with therapeutic decisions of pediatric neurologists in spinal muscular atrophy, identifying treatment preferences and evaluating the role of behavioral aspects such as therapeutic inertia, herding, regret, and workplace burnout.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0264006","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T18:43:43Z","timestamp":1644950623000},"page":"e0264006","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic decisions under uncertainty for spinal muscular atrophy: The DECISIONS-SMA study protocol"],"prefix":"10.1371","volume":"17","author":[{"given":"Gustavo","family":"Saposnik","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7097-0665","authenticated-orcid":true,"given":"Paola","family":"D\u00edaz-Ab\u00f3s","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"S\u00e1nchez-Men\u00e9ndez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"\u00c1lvarez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Terzaghi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9858-3555","authenticated-orcid":true,"given":"Jorge","family":"Maurino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Bra\u00f1as-Pampill\u00f3n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4074-6870","authenticated-orcid":true,"given":"Ignacio","family":"M\u00e1laga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"issue":"4","key":"pone.0264006.ref001","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.ncl.2015.07.004","article-title":"Spinal muscular atrophy","volume":"33","author":"SJ Kolb","year":"2015","journal-title":"Neurol Clin"},{"issue":"1","key":"pone.0264006.ref002","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s13023-017-0671-8","article-title":"Prevalence, incidence and carrier frequency of 5q-linked spinal muscular atrophy\u2014a literature review","volume":"12","author":"IEC Verhaart","year":"2017","journal-title":"Orphanet J Rare Dis"},{"issue":"2","key":"pone.0264006.ref003","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.nmd.2017.11.005","article-title":"Diagnosis and management of spinal muscular atrophy: part 1: recommendations for diagnosis, rehabilitation, orthopedic and nutritional care","volume":"28","author":"E Mercuri","year":"2018","journal-title":"Neuromuscul Disord"},{"key":"pone.0264006.ref004","doi-asserted-by":"crossref","first-page":"783","DOI":"10.3389\/fneur.2020.00783","article-title":"Editorial: Spinal muscular atrophy: evolutions and revolutions of modern therapy","volume":"11","author":"RS Finkel","year":"2020","journal-title":"Front Neurol"},{"issue":"3","key":"pone.0264006.ref005","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.nmd.2017.11.004","article-title":"Diagnosis and management of spinal muscular atrophy: part 2: pulmonary and acute care; 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