Decision-Making Process for Treating Multiple Sclerosis

Fred Lublin, MD: Let’s move along and talk a little bit about engaging patients because shared decision-making is something that gets a lot of lip service, but in this disease, it is extremely important. Patricia, why don’t you say a little bit about that?

Patricia K. Coyle, MD: Shared decision-making is very important. Knowledge is power. It’s the patient’s disease; they have to live with the treatment, so you want to engage them. You want them to be a partner, you want to instruct them, and you want them to understand realistic expectations from the therapy, how they need to follow-up, and what we would be looking for so that they buy into the treatment. Shared decision-making does not mean you ask the patient, “What do you want to go on?” Shared decision-making does not mean the doctor decides, “This is what you’re going to go on.” Shared decision-making means we communicate. We elicit what is important to the patient. We tell them what we feel is in their best interest based on our acute assessment of their disease, their particular desires, and the drug properties, and we make a strong recommendation, but we’re choosing as a partner, and that gets adherence. That gets buy-in from the patient.

Fred Lublin, MD: Wallace?

Wallace Brownlee, MBChB, PhD, FRACP: We have to work as partners with our patients as Patricia said, and you can bet your bottom dollar that, if you put a patient on a treatment they do not want to be on, they’re not going to take it.

Fred Lublin, MD: Sven?

Sven Meuth, MD, PhD: If we want to have a relationship over time with our patients, we have to go for shared decision-making because if we decide something and it is not working, we will lose the patient, maybe forever, and we will not have a second chance. If we explain our rationale, if we give a strong recommendation, and as mentioned before, if we convince the patients that the decision is in their best interest, then it’s a shared decision. If then something is not working, we have quite a good chance that the patient returns to us for a second guess and a second shot.

Fred Lublin, MD: There is an important clinical skill involved in this, and that is reading what the patient wants from you. We’ve seen criticism of both ends, of people saying, “The doctor didn’t pay any attention to what I wanted to do with my body,” to the other side, people saying, “I went to this physician for them to tell me what I needed to do for my disease, and they kept asking me what I wanted to do.” There is a certain skill in there to figuring out how to best meet the patients’ needs and incorporate that into the decision-making.