Schlegel Vincent, Leray Emmanuelle
Int J MS Care. 2018 Nov-Dec;20(6):279-286. doi: 10.7224/1537-2073.2017-043.
Approximately 12 disease-modifying treatments are available worldwide for patients with relapsing multiple sclerosis (MS). These recent therapeutic advances have led to major changes in patient and neurologist attitudes toward drug prescription. Herein, we aimed to characterize patient choice regarding treatment for MS and identify how neurologists assess and monitor patient compliance during follow-up.
In 29 patients with MS, we observed visits to their neurologist to understand how questions related to compliance were addressed in the doctor-patient relationship. Face-to-face interviews were conducted with 15 of the 29 patients to discuss how they dealt with their drug prescription from a patient-centered perspective.
Of the 15 patients with MS, nine were offered a choice of treatment. However, we found that neurologists were not always willing to consider the patients' input. Even if physicians attempt to align treatment choice with patient preferences to ensure compliance, preferences are often assumed rather than solicited from patients. Furthermore, patients may be unwilling to make their own treatment decisions. Various ways for neurologists to assess compliance during visits were also identified. Noncompliance can be considered as a way for patients to communicate their preferences and demonstrate involvement in their drug therapy, and it can lead to a renegotiation of the current treatment course.
These findings suggest that the neurologist-patient relationship has a great influence on patient compliance throughout the MS disease course.
全球范围内可供复发型多发性硬化症（MS）患者使用的疾病修饰治疗方法约有12种。这些最新的治疗进展已使患者和神经科医生对药物处方的态度发生了重大变化。在此，我们旨在描述MS患者在治疗选择方面的情况，并确定神经科医生在随访期间如何评估和监测患者的依从性。
我们观察了29例MS患者就诊神经科医生的情况，以了解医患关系中与依从性相关的问题是如何处理的。对29例患者中的15例进行了面对面访谈，从以患者为中心的角度讨论他们如何处理药物处方。
在15例MS患者中，有9例获得了治疗选择。然而，我们发现神经科医生并不总是愿意考虑患者的意见。即使医生试图使治疗选择与患者偏好一致以确保依从性，偏好通常也是被假定的，而非向患者征求的。此外，患者可能不愿意自己做出治疗决定。我们还确定了神经科医生在就诊期间评估依从性的各种方法。不依从可被视为患者表达其偏好并表明参与药物治疗的一种方式，并且可能导致对当前治疗方案的重新协商。
这些发现表明，在整个MS病程中，医患关系对患者依从性有很大影响。
