Best Methods of Communicating Clinical Trial Data to Improve Understanding of Treatments for Patients with Multiple Sclerosis

摘要

Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.