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A pilot study to improve adherence among MS patients who discontinue treatment against medical advice

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Abstract

Between 30 and 50 % of MS patients may prematurely discontinue disease modifying therapies. Little research has examined how to best talk with patients who have discontinued treatment against medical advice. The aim of this pilot study was to determine whether telephone counseling increases disease modifying therapy (DMT) re-initiation among nonadherent patients with multiple sclerosis (MS). Participants were eligible if they had relapsing-remitting disease, had stopped taking a DMT, and had no plan to re-initiate treatment despite a provider recommendation. Following a baseline assessment, 81 patients were randomly assigned to either five 20 min, weekly sessions of Motivational Interviewing/Cognitive Behavioral Therapy (MI-CBT) or Treatment as Usual (TAU) with brief education. At 10 weeks, patients initially assigned to TAU switched over to MI-CBT. Compared to patients in the TAU group, patients undergoing MI-CBT were significantly more likely to indicate they were re-initiating DMT (41.7 vs. 14.3 %). These significant results were replicated among patients crossing over from TAU to MI-CBT. Treatment satisfaction was high, with 97 % of participants reporting that they would recommend MI-CBT to other patients with MS. Results of this pilot study provide initial support for the use of MI-CBT among MS patients who have discontinued treatment against medical advice.

Clinicaltrials.gov: NCT01925690.

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Acknowledgments

This work was funded by a grant from the National Multiple Sclerosis Society (HC 0138) to the first author.

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Authors and Affiliations

  1. Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA

    Jared Bruce, Joan Thelen, Abigail Ness, Morgan Glusman & Delwyn Catley

  2. Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA

    Amanda Bruce

  3. Children’s Mercy Hospital, Kansas City, MO, USA

    Amanda Bruce

  4. Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA

    Sharon Lynch

  5. Kessler Foundation, West Orange, NJ, USA

    Lauren Strober

  6. Texas Tech University, Lubbock, TX, USA

    Sean O’Bryan

  7. Saint Luke’s Health System, Kansas City, MO, USA

    Deborah Sobotka

  8. Health Services and Outcome Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA

    Kathy Goggin & Andrea Bradley-Ewing

  9. Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA

    Kathy Goggin

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  1. Jared Bruce
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  2. Amanda Bruce
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  7. Joan Thelen
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  9. Morgan Glusman
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  12. Delwyn Catley
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Corresponding author

Correspondence to Jared Bruce.

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Conflict of interest

Jared Bruce provides unbranded talks as a member of the Novartis Speaker’s Bureau. He has also received research funding from Cephalon and is a paid consultant to the National Hockey League. Amanda Bruce, Sharon Lynch, Lauren Strober, Sean O’Bryan, Deborah Sobotka, Joan Thelen, Abigail Ness, Morgan Glusman, Kathy Goggin, Andrea Bradley-Ewing and Delwyn Catley declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients included in the study.

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Bruce, J., Bruce, A., Lynch, S. et al. A pilot study to improve adherence among MS patients who discontinue treatment against medical advice. J Behav Med 39, 276–287 (2016). https://doi.org/10.1007/s10865-015-9694-6

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  • DOI: https://doi.org/10.1007/s10865-015-9694-6

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