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Treating multiple sclerosis with information

In this issue Solari et al. report on the first prospective systematic approach to monitoring the disclosure of the diagnosis of multiple sclerosis (MS) and, additionally, the effects of an intervention. In this randomized, controlled trial carried out in five Italian centres, a one hour physician-guided computer-based information session was added to standard diagnosis disclosure procedures. Disease knowledge and satisfaction with care were improved in the intervention group not only after four weeks but also six months later. Unmet needs in giving the diagnosis have been repeatedly underlined by persons with MS in retrospective studies, and substantial distress and psychological burden have been reported leading even to trauma-like reaction patterns among persons with MS. Solari et al.’s study clearly shows that, even at the very early stage, thorough information if guided by patients’ choices is helpful. It adds to previous work indicating that involving patients with symptoms suggestive of MS in the diagnostic process is appreciated by them. Balanced information including scientific uncertainties seems to be highly appreciated by MS patients. At the time of increasingly complex treatment options in MS, where benefits and risks need continuous updating, information and reflection about preferences and values becomes highly relevant. While, on the one hand, patients are overwhelmed by information through media such as the internet, very few sources of information are based on rigorous guidelines on evidence-based patient information. It has been argued that information and education should be regarded as treatment which needs evaluation similar to a drug with a phase 1 to 3 approach followed by implementation studies. But is there any evidence that these resource-consuming efforts lead to better health outcomes? Coulter and Ellins have reviewed the current evidence on education programmes in medicine. A substantial number of studies have shown improved health behaviour and health status. As cited by Solari et al., several recent studies have shown after educational interventions the beneficial effects of educational and behavioural interventions in MS. Faced with the limitations of current drug treatments and based on the increased understanding of behaviour and psychological status on brain functioning every effort should be undertaken to make use of this approach to enhance patients’ activity and participation.