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Adherence to Disease-Modifying Therapy in Multiple Sclerosis: Part I

Holland, Nancy EdD RN; Wiesel, Phyllis BSN RN; Cavallo, Pamela MSW CSW; Edwards, Clayton MBA RPh PAHM; Halper, June MSN ANP FAAN; Kalb, Rosalind PhD; Morgante, Linda MSN RN CRRN; Namey, Marie MSN RN; O'Leary, Margie MSN RN; Smith-Williamson, Lori MSN RN C-ANP

doi: 10.1002/j.2048-7940.2001.tb01946.x
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Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure. However, the recent introduction of injectable immunomodulating agents has made it possible to reduce the frequency of relapsing episodes and to possibly slow its progression. The use of these agents is recommended by the National MS Society, however, their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Because MS is unpredictable, and treatments can produce side effects, ensuring adherence to the recommended therapy is a complex and challenging issue. A better understanding of the obstacles to adherence, and the identification of possible solutions, should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. This article, which is in two parts, describes the particular problems of treatment adherence, and proposes that the transtheoretical model of behavior change can be useful in achieving treatment goals in MS and in other chronic disease states. This model is based upon the concept that a patient's “readiness for change” is crucial, and that attempts at intervention should be sensitive to the patient's changing conditions and state of mind. Nurses who work with patients with MS and other chronic diseases can apply the model to help their patients accept and adhere to the demands of ongoing treatment.

National Multiple Sclerosis Society, 733 Third Avenue, New York, NY 10017 or e-mail nancy.holland@nmss.org.

Nancy Holland is vice president of the clinical programs department at the National Multiple Sclerosis Society's home office in New York City. Phyllis Wiesel is a former director of clinical services at the New York City chapter of the National Multiple Sclerosis Society. Pamela Cavallo is a director emeritus of the clinical programs department of the National Multiple Sclerosis Society. Clayton Edwards is the director of health management at Merck-Medco Managed Care, LLC, in Montvale, NJ. June Halper is the executive director of Gimbel MS Center in Teaneck, NJ. Rosalind Kalb is the director of Information Resources at the National Multiple Sclerosis Society. Linda Morgante is the director of clinical services at the Maimonides Medical Center in Brooklyn, NY. Marie Namey is an advanced practice nurse at The Mellen Center of the Cleveland Clinic Foundation in Cleveland, OH. Margie O'Leary is a clinical nurse at the University of Pittsburgh Medical MS Center in Pittsburgh. Lori Smith-Williamson is an adult nurse practitioner at Drs. Cochran, Eberly & Howe, P.C., in Alexandria, VA.

© 2001 Association of Rehabilitation Nurses.
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