Optimized Conversations Suggested to Improve Patient Outcomes in Multiple Sclerosis

Cortnee Romàn, FNP-C

Conversations between health care providers (HCPs) and patients with multiple sclerosis (MS) should be open and optimized to best suit the patient’s needs, while also building trust and an understanding of a shared decision-making process, findings from a new study suggest.

Cortnee Romàn, FNP-C, Rocky Mountain Multiple Sclerosis Clinic and Research Group, Salt Lake City, led investigators, with Bryan Walker, MHS, PA-C, department of neurology, Duke University School of Medicine, presenting findings at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28. Four practical strategies to be adopted and implemented by HCPs were proposed: (1) utilizing plain-language techniques, (2) implementing teach-back—a communication method for HCPs to ensure that patients understand the information that is being provided to them, (3) using open-ended questions, and (4) practicing active listening/paraphrasing. These suggestions were developed following the discovery that better conversations were supported by patient resources outlining the basics of health care. 

When discussing previous conversations with patients, the group of advanced practice providers (APPs) found that there were several recurring themes, including what specific information to look for and where, reliable and unreliable sources, as well as overpromising language. Investigators noted that when patients were misinformed, it was often fueled by information found online or information that came from social media. 

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“Robust health literacy, defined by the Centers for Disease Control and Prevention as the degree to which an individual can obtain, communicate, and understand health information/services, is key to helping patients improve their outcomes and is particularly important for individuals managing chronic illnesses such as MS,” Romàn et al wrote. “Low health literacy in people with MS has been associated with negative health behaviors and increased emergency room visits. Variable levels of health literacy among patients also impacts effective communication between providers and patients. As HCPs continue to strive towards optimal patient-centric care, it is critical to raise awareness of conversational techniques and enhance practice behaviors for effective communication with people with MS."

During his presentation, Walker outlined the cross-sectional study of health literacy among NARCOMS Registry participants, in which 9019 patients with MS completed a questionnaire regarding health literacy. The questionnaire included both the METER and the Newest Vital Sign (NVS) instruments to measure responses.

"While the majority of respondents performed well on health literacy instruments, 34.48% of persons living with MS did not, and we know that by these 2 metrics, the METER test and the NVS instrument, up to a third of patients did not do very well at all—over a third actually," Walker said during his presentation at CMSC 2021. "When we adjusted for income, disability, and cognitive impairment, low health literacy correlated with a decrease in the probability of emergency room visits and hospitalizations," this was across all visits, not just those associated with MS.

In addition to reviewing literature on the topic, APPs set out to highlight different conversational tactics that coincide with clinical practice to devise practical and impactful multimodal strategies for patients with MS, in order to speak to differing health literacy levels. 

In a recent Peer Exchange series, the NeurologyLive team recently sat down with APPs to discuss the optimal management of patients with relapsing MS, including recommendations for selecting and sequencing therapies. They offered their advice and resources for their colleagues, including community practitioners and neurologists, to encourage collaboration and best support for patients with MS, as well as discuss the management of patients in depth.

For more coverage of CMSC 2021, click here.

REFERENCE

Romàn C, Fine C, Bruen DR, et al. The art of the patient conversation: Advanced practice provider perspectives to improve outcomes in multiple sclerosis. Presented at CMSC 2021; October 25-28, 2021. Abstract PSY03.