Patient education program to enhance decision autonomy in multiple sclerosis relapse management: a randomized-controlled trial.
BACKGROUND
Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis (MS), uncertainty remains about most aspects of relapse management. Oral corticosteroids administered by physicians or patients themselves or no corticosteroids also appear justifiable.


OBJECTIVE
To evaluate an education program that aims to involve patients with MS in decisions on relapse management.


METHODS
In three German MS centers, 150 patients with relapsing MS were randomly assigned to a single, 4-h group session or a standard information leaflet. The primary outcome measure was the proportion of relapses with oral or no corticosteroid therapy as an indicator of patient autonomy in treatment decision making. Other outcomes included perceived decision autonomy, quality of life, and disability status.


RESULTS
In the intervention group (IG), 108/139 (78%) relapses were treated with oral or no corticosteroids compared with 101/179 (56%) in the control group; P < 0.0001. Patients' perceived autonomy of treatment decision making was significantly higher in the IG; P < 0.0001. Quality of life, disability status, and adverse events of corticosteroid therapies were comparable.


CONCLUSIONS
The patient education program led to more autonomous decision making in patients with relapsing MS. Relevant changes in relapse management were observed.
Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany. sascha.koepke@uni-hamburg.de
S
S
Köpke
J
J
Kasper
I
I
Mühlhauser
M
M
Nübling
C
C
Heesen
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy / Q000523:psychology*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D026684:Personal Autonomy; D011788:Quality of Life; D055502:Secondary Prevention
D000305:Adrenal Cortex Hormones