Department of Psychology and Department of Biomedical and Health Informatics, University of Missouri-Kansas City.
Department of Applied Behavior Science, University of Kansas-Lawrence.
Health Psychol. 2018 Jul;37(7):680-690. doi: 10.1037/hea0000626. Epub 2018 Jun 4.
Although the effectiveness and risks of multiple sclerosis (MS) therapies are established, relatively little is known about how these benefits and risks are perceived and weighed by patients. This risk-benefit trade-off is important for clinicians, industry, and regulators to consider when determining which therapies to develop, approve for clinical use, and recommend to individual patients. The primary objective of the present study was to describe individual differences in how MS patients weigh risks and benefits when making treatment decisions.
Two hundred ninety patients with MS completed tasks assessing their willingness to take a hypothetical disease-modifying therapy (DMT) at varying levels of efficacy, side effect probability, and side effect severity. Patients also completed questionnaires assessing MS knowledge, medication beliefs, health care climate, and disease severity.
Patients with a primary progressive course reported increased DMT willingness compared to patients with relapsing-remitting and secondary progressive courses. Patients were less willing to initiate a DMT across a range of efficacies and side effects if they had never taken a DMT, reported more complementary and alternative health beliefs, or reported a history of discontinuing DMTs due to side effects. More MS knowledge was associated with more willingness to initiate a DMT.
The results represent an initial step in understanding how patients with chronic disease balance the risks and benefits of medication initiation. Extension of this research may have implications for pharmaceutical development, physician-patient interaction, adherence intervention, and disease education. (PsycINFO Database Record
尽管多发性硬化症（MS）治疗的疗效和风险已得到证实，但对于患者如何感知和权衡这些益处和风险，人们知之甚少。对于临床医生、行业和监管机构来说，这种利弊权衡在确定开发哪些疗法、批准用于临床使用以及向个体患者推荐哪些疗法时非常重要。本研究的主要目的是描述 MS 患者在做出治疗决策时权衡风险和益处的个体差异。
290 名 MS 患者完成了评估他们在不同疗效、副作用概率和副作用严重程度水平下接受假设性疾病修正治疗（DMT）的意愿的任务。患者还完成了评估 MS 知识、药物信念、医疗保健环境和疾病严重程度的问卷。
与复发缓解型和继发进展型患者相比，原发性进展型病程的患者报告的 DMT 意愿更高。如果患者从未服用过 DMT、报告了更多的补充和替代健康信念，或因副作用而报告了停用 DMT 的病史，则他们对在一系列疗效和副作用下启动 DMT 的意愿较低。更多的 MS 知识与更高的 DMT 起始意愿相关。
这些结果代表了理解慢性病患者如何权衡药物起始的风险和益处的初步步骤。这项研究的扩展可能对药物开发、医患互动、依从性干预和疾病教育具有重要意义。
