Over the last few decades, there have been unprecedented advances in our capacity to treat medical disorders. Neurological disease in particular has made significant strides. While a cure may still be beyond our reach in many conditions, we are able to reduce suffering and improve quality of life in a way that would have been unimaginable some decades ago.
In my own multiple sclerosis clinic, older patients lament the fact that they were diagnosed with this disabling illness at a time when there was little that could be offered in the way of treatment, aside from steroids. While the interferons proved to be a significant step forward, it is only recently that we have had the means to offer MS patients a wide variety of potential therapies, acting on different pathophysiological pathways.
This progress also means that it is highly possible for many patients to become very confused and overwhelmed by the possibilities that exist. As if thinking about the impact of the illness on one’s life is not enough in itself, suddenly they are forced to make decisions that require a lot of background knowledge. Doctors these days also stand back more than they used to. We provide information and we say “well here it is…let me know what you want to do”. Welcome to informed choice.
In this issue of JNNP, Kopke and colleagues make an important contribution that underscores the importance of education in empowering MS patients. They undertook a randomised study that explored the potential benefits of an evidence-based educational programme, compared with an MS-specific stress management programme. They demonstrated increased autonomy and a substantial increase in knowledge in the treatment arm compared to the control arm. In their conclusions, they highlight the fact that their study also provides some evidence that patients are more likely to opt for treatment, rather than less likely, once they have been educated regarding key aspects of the disease and the potential treatments. As Hippocrates said, “cure sometimes, treat often, comfort always”.
How do you educate patients regarding illness? Do you think the intervention administered by Kopke is workable in clinical practice?
(1) Kopke et al. Evidence-based patient information programme in early multiple sclerosis: a randomised controlled trial. 2014;85:411-418 doi:10.1136/jnnp-2013-306441