Decision Making in Multiple Sclerosis: Theory to Practice

Multiple sclerosis (MS) is an uncertain disease that manifests itself in neurological symptoms unique to each individual. People with MS and their families experience the day-to-day variability of the disease and often face difficult decisions regarding their care. Decisions include opting for a disease-modifying therapy soon after the diagnosis of MS is confirmed, choosing various pharmaceutical and nonpharmaceutical treatments for managing the symptoms that result, changing therapies and selecting alternatives when prescribed treatments are not successful, and determining whether to enter a clinical trial of a promising medication. When new therapies become available, nurses are faced with the important task of clarifying expectations, helping patients understand the risks and benefits of the new agent and, if appropriate, the rationale for continuing on their current regimen rather than switching therapies. Patients should be taught to appraise how they are doing on their current treatment and then weigh the evidence of something new in the light of their personal disease course and information available from the media and from peers. A framework for helping patients and families to make complicated decisions is an important step in continuing to provide high-quality care. This can be considered a new domain of MS nursing—one that includes consideration of the patient's hopes and dreams combined with the reality of the evidence. Principles of adult learning, cultural sensitivity, and state-of-the-art nursing knowledge are needed by MS nurses more than ever. The future of MS treatment is one of optimism despite its complexity.