Association of Physician-Patient Communication and Treatment Satisfaction with Adherence to Disease-Modifying Therapies Among Patients with Relapsing-Remitting Multiple Sclerosis: A Cross-Sectional Study.

Abstract

Background: Adherence to disease modifying therapies (DMTs) is essential for treatment outcomes in relapsing-remitting multiple sclerosis (RRMS). Non-adherence has been associated with an increased risk of relapses, disease progression and higher healthcare costs; therefore, it is essential to identify factors associated with adherence.

Purpose: The aim of the study was to evaluate self-reported adherence to therapeutic recommendation among patients with RRMS and to examine its associations with treatment satisfaction and physician-patient communication.

Material and methods: This cross-sectional online survey study included 165 patients with RRMS (67.27% women), with mean age 44.42 ± 10.43 years, treated at the Department of Neurology, Wroclaw Medical University. Adherence was assessed using the Adherence in Chronic Diseases Scale (ACDS), physician-patient communication with the 14-item Polish version of the Communication Assessment Tool (CAT), and treatment satisfaction with the SATMED-Q questionnaire. Associations with the ACDS score were examined by univariable linear regression and by a multivariable model specified a priori on conceptual and clinical grounds (CAT, SATMED-Q, age, sex, EDSS, comorbidities, place of residence, route of administration and disease duration), supported by regression diagnostics and by ordinal and robust-regression sensitivity analyses.

Results: The mean ACDS score was 25.49 ± 2.51 (range 14-28). Applying the established cut-offs, 8 participants (4.8%) were classified as showing low, 80 (48.5%) intermediate and 77 (46.7%) high adherence. Patients reported high satisfaction with physician communication (mean CAT score: 61.61 ± 9.73) and with treatment (mean total SATMED-Q score 78.67 ± 15.91). In the a-priori multivariable model (n = 165; R ² = 0.226, adjusted R ² = 0.171, overall F p < 0.001), higher CAT scores (adjusted β = 0.058 per point, 95% CI 0.019 to 0.098, p = 0.004) and higher total SATMED-Q scores (adjusted β = 0.031, 95% CI 0.005 to 0.057, p = 0.018) were associated with higher self-reported adherence, whereas a higher EDSS score was associated with lower adherence (adjusted β = -0.552, 95% CI -0.857 to -0.247, p < 0.001). All three associations were of modest magnitude and were confirmed in ordinal and robust-regression sensitivity analyses (overall F(11,153) = 4.07, p < 0.001).

Conclusion: In this single-centre cross-sectional sample of patients with RRMS, higher self-reported treatment satisfaction and more favourable ratings of physician-patient communication were associated with modestly higher self-reported adherence scores, while greater disability was associated with lower adherence. Longitudinal and intervention studies are required to establish directionality and to determine whether communication-focused or shared decision-making interventions can improve adherence to disease-modifying therapies.