“We saw a need to improve communication between patients and clinicians so that patients feel comfortable being part of the decision process.”

“Six years ago, there was a ‘call to action’ by the National Quality Forum to implement policies that integrate shared decision making (SDM) into practice to improve communications between clinicians and their patients with MS,” explains Elaine Rudell, PhD, CHCP.  In response, Projects In Knowledge Powered by Kaplan initiated several SDM studies, the most recent of which was completed at the MS Comprehensive Care Center, Stony Brook Neurosciences Institute, with Patricia Coyle, MD, and her team.

“In MS, as with other chronic diseases, patients have many concerns about their treatment and options for managing their healthcare but are often reluctant to raise questions with their clinicians,” Dr. Rudell says. “There was a need to improve communication between patients and clinicians so that patients feel comfortable raising questions and being part of the decision process.”

Dr. Rudell and colleagues presented their remarks at The Consortium of Multiple Sclerosis Center (CMSC), held from May 31 to June 3, 2023, in Aurora, Colorado.

Study Team Analyzed Educational Training Interventions for MS

SDM involves communication between a patient and clinician that allows them to work together to make optimal decisions that align with what is important to that patient, Dr. Rudell points out. To achieve this, the study team sought to observe whether educational training interventions for patients and their clinicians—covering SDM as well as symptom and wellness management—would improve patient-clinician communications, she says.

They conducted a four-arm trial with patients with MS in group 1A (control) and group 1B (trained) seen by untrained clinicians, and patients with MS in group 2A (control) and group 2B (trained) seen by trained clinicians receiving similar SDM, symptom, and wellness education. Patient assessments included the Decisional Conflict Scale (DCS, which measures five aspects of decision making) and qualitative semi-structured interviews of a subset of 12 patients in the intervention groups.

The study team observed that in comparing DCS scores in patients from baseline to end of pilot, patients in group 1B revealed a statistically significant improvement (P=0.024) in their scores versus group 1A, which showed little improvement (P=0.16). For group 2A versus group 2B, in comparing DCS score of patients from baseline to end of pilot, group 2B patients revealed a trend for improvement (P=0.25), whereas group 2A showed a worsening trend (P=0.12). DCS scores for patients in groups 1B and 2B improved regardless of whether their clinicians were untrained or trained.

“Patient assessments showed educational training empowered patients to ask questions and feel more in control of their healthcare,” Dr. Rudell notes. “As one patient intimated, there is so little they can control in the progression of their MS that feeling empowered to ask questions and make better shared decisions with their clinicians is extremely important. As a result of their educational training, they now felt they had ‘permission’ to ask questions. Several patients also explained how they had improved communication with their clinicians, as well as improved their diet and exercise regimen.”

Neurologists Should Encourage Patients With MS to Ask Questions

Since many patients are yet untrained in SDM and communication techniques, neurologists and their team members should encourage patients to ask them questions about their health concerns and MS. They can also provide patients with vetted information and websites about SDM, MS, and wellness management. “This will empower patients to make more informed decisions,” Dr. Rudell says.

“It is very important to extend the reach of SDM educational intervention programs to patients and clinicians at institutions and their networks to optimize patient-centric care, as well as patient and clinician satisfaction,” she adds. “I am certain that with the innovative leadership of Projects In Knowledge Powered by Kaplan and ongoing support for these programs, we will see many more state-of-the-art educational SDM initiatives.”

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