Improving Patient-Clinician Communication and Treatment Adherence

Although there have been significant advances in multiple sclerosis management, patient preferences need to be taken into account before choosing treatment, according to speakers at the 2014 ACTRIMS-ECTRIMS Joint Meeting in Boston, Massachusetts.

Per Soelberg Sørensen, MD, DMSc, head of MS Research Unit at the Danish Multiple Sclerosis Center at Copenhagen University Hospital, reminded attendees that there could be differences between the patient’s and the physician’s perception of disease management and outcomes, as well as what side effects can be expected.

Instead of telling patients which treatment the clinician believes is good or bad, inform them about the studies and provide the numbers, Sascha Köpke, PhD, from the University of Lübeck said. He added that patients who know and understand the results of studies will know what to expect during treatment and will have realistic expectations.

“It’s clear that if patients think they will be cured, which they won’t — at least not now — they will be disappointed rather quickly,” Köpke said.

He emphasized empathizing with the patients and making sure that clinicians don’t come across as being patronizing. Fostering an environment of shared decision-making isn’t always easy, but it prevents bad relationships from forming and medication nonadherence from occurring.

It’s also important for physicians to address the topic of adherence to understand whether or not patients take their medication as prescribed and if they aren’t, then why that is the case. By getting to the core of what could be causing nonadherence, providers can assist patients and get them back on track.

“We know very well that patients want to be involved, and we know patients can be involved,” he said. “And involvement, in my view, really needs patient-based information.”

There are 6 steps to creating a shared decision-making experience:

1. Invite the patient to participate
2. Present options
3. Provide information on benefits and risks
4. Assist in evaluating options based on goals and concerns
5. Facilitate deliberation and decision-making
6. Assist with implementation

However, providers have to be prepared for a potential scenario that invalidates the 6 steps: sometimes patients decide to do nothing and opt not to go on disease-modifying drugs, Köpke said.