Department of Psychology, Royal Holloway, University of London, Egham, UK.
Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK.
Value Health. 2018 Jul;21(7):762-766. doi: 10.1016/j.jval.2017.12.015. Epub 2018 Feb 9.
Patients' understanding of treatment risks and benefits is a prerequisite for shared decision making. Yet, patients with multiple sclerosis (MS) do not accurately understand treatment information provided in regular clinical consultations.
To identify the best methods of communicating clinical trial data to improve the understanding of treatments among patients with MS and to also examine the relationship between patients' understanding with decisional conflict, individual traits, and MS symptoms.
A repeated-measures study was used. A sample of relapsing-remitting patients with MS was recruited from National Health Service sites in the United Kingdom. Patients were presented with hypothetical treatment risks and benefits from faux clinical trials. Treatments were communicated using absolute terms, relative terms, and numbers needed to treat/harm. The presence of baseline information with each method was also manipulated. Patients' understanding and conflict in treatment decisions were assessed. Individual traits and MS symptoms were also recorded.
Understanding was better when treatments were communicated in absolute terms (mean 3.99 ± 0.93) compared with relative terms (mean 2.93 ± 0.91; P < 0.001) and numbers needed to treat/harm (mean 2.89 ± 0.88; P < 0.001). Adding baseline information to all methods significantly improved understanding (mean 5.04 ± 0.96) compared with no baseline information (mean 1.50 ± 0.74; P < 0.001). Understanding was not related to conflict in treatment decisions (r = -0.131; P = 0.391). Numeracy, IQ, and cognitive impairments were significantly related to patients' understanding of treatments.
Treatment risks and benefits should ideally be communicated using absolute terms, alongside baseline information. Patients with MS with low numeracy, low IQ, and reduced cognitive skills should be supported during treatment education.
患者对治疗风险和益处的理解是共同决策的前提。然而，多发性硬化症（MS）患者并不能准确理解常规临床咨询中提供的治疗信息。
确定向 MS 患者传达临床试验数据的最佳方法，以提高他们对治疗的理解，并研究患者理解与决策冲突、个体特征和 MS 症状之间的关系。
采用重复测量研究。从英国国民保健署的站点招募了复发缓解型 MS 患者样本。向患者展示了来自虚假临床试验的假设治疗风险和益处。使用绝对术语、相对术语和需要治疗/伤害的人数来传达治疗方法。还对每种方法的基线信息的存在进行了操作。评估了患者对治疗的理解和决策冲突。还记录了个体特征和 MS 症状。
与相对术语（平均 2.93 ± 0.91；P < 0.001）和需要治疗/伤害的人数（平均 2.89 ± 0.88；P < 0.001）相比，以绝对术语传达治疗方法时，理解更好。向所有方法添加基线信息可显著提高理解（平均 5.04 ± 0.96），而不添加基线信息时（平均 1.50 ± 0.74；P < 0.001）。理解与治疗决策冲突无关（r = -0.131；P = 0.391）。计算能力、智商和认知障碍与患者对治疗的理解显著相关。
理想情况下，应使用绝对术语和基线信息来传达治疗风险和益处。计算能力低、智商低和认知能力下降的 MS 患者在接受治疗教育时应得到支持。
