Bruce et al. A pilot study to improve adherence among MS patients who discontinue treatment against medical advice. J Behav Med. 2015 Nov 12.
Background: 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.
Aim: The aim of this pilot study was to determine whether telephone counseling increases disease modifying therapy (DMT) re-initiation among non-adherent patients with multiple sclerosis (MS).
Methods: 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.
Results: 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.
Conclusions: Results of this pilot study provide initial support for the use of MI-CBT among MS patients who have discontinued treatment against medical advice.