Counseling Points Multiple Sclerosis - Spring 2015 - 9

PML reached 2 in 10,000 persons (compared with
49% of physicians who would stop the therapy).44
The authors also concluded that "patients had a
significantly worse perception of MS as a malignant disease," than did the neurologists surveyed.
Patients also indicated being open to information
about treatment-related risk and the shared decision-making process.44
To what degree can people with MS-or even
health professionals-understand the complex balance of risk and benefit associated with medical
treatment? People watching consumer drug advertisements on television are often overwhelmed
(or even bemused) by the long array of potential
adverse effects that seem to overshadow any possible benefit of the drug. Research shows that these
ads often lack the basic contextual information
that could help a consumer to make an informed
decision. Thus, most people "tune out" the information without being able to consider what it
may mean for them.45,46
The North American Research Committee
on Multiple Sclerosis (NARCOMS) Registry
allows researchers to tap into real-world views
and experiences of a large population of people
with MS. Using NARCOMS data, Robert Fox
and colleagues recently explored how people with
MS who are using a variety of therapies view the
concept of risk. As described in the Sidebar, these
authors found a wide spectrum of risk tolerance,
with some variation based on gender, patient age,
and severity of disease.47

Shared decision making is a concept that focuses
on patient-provider communication in the medical decision-making process. In the exchange of
information between the provider and the patient,
the patient is encouraged to communicate values,
risk attitudes, and treatment goals. 44,48 Research
about medication-taking risks in general indi-

"Individual patients do not experience
'likelihood,' or population-level rates of
events.They experience single outcomes
(something happens or does not)."
cates that patients tend to underestimate common
risks, but overestimate the rarer risks. Furthermore,
patients may respond to risks primarily on the
basis of emotion rather than facts.41 "Individual
patients do not experience 'likelihood,' or population-level rates of events," authors Moore and
colleagues observe. "They experience single outcomes (something happens or does not). People
making decisions may be frightened or too ill to
process complex information and make appropriate decisions."41 Statistical representations are
often used to describe the risks of certain treatments, but patients' have a limited ability to
understand concepts such as relative risk reduction
(RRR). It is also important to consider that each
patient will have different priorities and risk tolerance and may change his or her perception and

Expanding Patient Communication
and Counseling Skills

tolerance of risk over time.49 Key issues related

Communicating risk and risk assessment is crucial
to enable shared decision making with patients.

summarized in Table 3.49

to discussion of treatment risks with patients are
Patients often answer "No" when asked if they
9

Spring 2015
Counseling Points Multiple Sclerosis - Spring 2015

Table of Contents for the Digital Edition of Counseling Points Multiple Sclerosis - Spring 2015
