Articles Related to Disease Modifying Treatment

Background: In Multiple Sclerosis, more efficient disease modifying treatment (DMT) are often accompanied by higher risks and side effects. Selecting the optimal DMT demands from patients and doctors therefore a complex decision-making process weighing risks and benefits. Patients and doctors often prefer to share responsibility when making these treatment decisions, but this shared decision-making model requests decision-making competence on both sides. The aim of our online study was to investigate whether patients’ decision-making competence relates to DMT selection. Method: 197 patients participated in the online survey, advertised by two patient organizations. Patients reported their DMT and who decided for or against a DMT: their neurologist, themselves, or both. We measured decision-making competence with two tasks from the Adult Decision-Making Competence Battery (A-DMC), the ability to follow decision rules and the consistency of risk perception. Perceived impairment of the disease was measured with Patient Determined Disease Steps (PDDS). Results: The ability to follow decision rules varied with the potency of the DMT. Patients receiving basic DMT were better able to follow decision rules compared to patients receiving medium DMT. Patients who did not take any DMT stated more frequently that this decision was their own choice and independent of their doctor’s advice. Conclusions: If patients without DMT decided against this treatment on their own behalf, doctors and caregivers potentially have to strengthen their effort to reach out to the patient and to ensure the decision is well taken.

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