Mohr D C, Goodkin D E, Likosky W, Gatto N, Neilley L K, Griffin C, Stiebling B
University of California, San Francisco, USA.
Mult Scler. 1996 Dec;2(5):222-6. doi: 10.1177/135245859600200502.
This study, conducted in three separate outpatient health care delivery settings, examined the therapeutic expectations of patients with multiple sclerosis (MS) before they initiated interferon beta-1b therapy, the results of current educational procedures to correct unrealistic expectations, and the relationship between post-education expectations and discontinuing therapy. Ninety-nine consecutive patients were seen in a university based outpatient MS clinic, an academic group practice outpatient MS clinic, or a health maintenance organization outpatient neurology clinic. Before the educational sessions, 57% of the patients expressed unrealistically optimistic expectations regarding reduction in attack rate and 34% expressed unrealistically optimistic expectations regarding improvement in functional status. Educational procedures significantly altered unrealistic expectations but the results were sub-optimal since 33% of the patients maintained overly optimistic expectations regarding reduction in attack rate. Post-education unrealistic expectations of improvement in functional status were significantly related to discontinuing therapy within 6 months. Three adverse effects of therapy also were related independently to adherence to treatment: depression and flu-like symptoms were related to discontinuing therapy while soreness at injection site was related to continuing therapy.
本研究在三个独立的门诊医疗服务机构中开展，调查了多发性硬化症（MS）患者在开始使用β-1b干扰素治疗前的治疗期望、当前纠正不切实际期望的教育措施的效果，以及教育后期望与停止治疗之间的关系。连续99名患者分别就诊于一所大学附属医院的门诊MS诊所、一个学术团体执业门诊MS诊所或一个健康维护组织门诊神经科诊所。在开展教育课程之前，57%的患者对发作率降低表达了不切实际的乐观期望，34%的患者对功能状态改善表达了不切实际的乐观期望。教育措施显著改变了不切实际的期望，但效果并不理想，因为33%的患者对发作率降低仍保持过度乐观的期望。教育后对功能状态改善的不切实际期望与6个月内停止治疗显著相关。治疗的三种不良反应也与坚持治疗独立相关：抑郁和流感样症状与停止治疗有关，而注射部位疼痛与继续治疗有关。
