title: A pilot study to improve adherence among MS patients who discontinue treatment against medical advice.
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.
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA. Brucejm@umkc.edu.
authors.forename: Jared
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.|Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bruce
authors.affiliation: Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lynch
authors.affiliation: Kessler Foundation, West Orange, NJ, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Strober
authors.affiliation: Texas Tech University, Lubbock, TX, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Bryan
authors.affiliation: Saint Luke's Health System, Kansas City, MO, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sobotka
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Thelen
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Ness
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Glusman
authors.affiliation: Health Services and Outcome Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.|Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.affiliation: Health Services and Outcome Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bradley-Ewing
authors.affiliation: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Delwyn
authors.initials: D
authors.lastname: Catley
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000523:psychology; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D010865:Pilot Projects; D013689:Telephone; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D018501:Antirheumatic Agents
keywords: Adherence; Cognitive behavioral therapy; Disease modifying therapy; Intervention; Motivational interviewing; Multiple sclerosis