Training physicians in providing complex information to patients with multiple sclerosis: a randomised controlled trial

OBJECTIVE: To evaluate the effect of a specific communication training for neurologists on how to provide complex information about treatment options to patients with multiple sclerosis (MS). DESIGN: Single-centre, single-blind, randomised controlled trial. SETTING: One university hospital in Norway. PARTICIPANTS: Thirty-four patients with early-stage MS. INTERVENTION: A 3-hour training for neurologists on how to provide complex information about MS escalation therapy. MAIN OUTCOME MEASURES: Patient recall rate, measured with a reliable counting system of provided and recalled information about drugs. SECONDARY OUTCOME MEASURES: Number of information units provided by the physicians. Effects on patient involvement through questionnaires. METHODS: Patients with MS were instructed to imagine a disease development and were randomised and blinded to meet a physician to receive information on escalation therapy, before or after the physician had participated in a 3-hour training on how to provide complex information. Consultations and immediate patient recall interviews were video-recorded and transcribed verbatim. RESULTS: Patient recall rate was 0.37 (SD=0.10) pre-intervention and 0.39 (SD=0.10) post-intervention. The effect of the intervention on recall rate predicted with a general linear model covariate was not significant (coefficient parameter 0.07 (SE 0.04, 95% CI (-0.01 to 0.15)), p=0.099).The physicians tended to provide significantly fewer information units after the training, with an average of 91.0 (SD=30.3) pre-intervention and 76.5 (SD=17.4) post-intervention; coefficient parameter -0.09 (SE 0.02, 95% CI (-0.13 to -0.05)), p<0.001. There was a significant negative association between the amount of provided information and the recall rate (coefficient parameter -0.29 (SE 0.05, 95% CI (-0.39 to -0.18)), p<0.001). We found no significant effects on patient involvement using the Control Preference Scale, Collaborate or Four Habits Patient Questionnaire. CONCLUSION: A brief course for physicians on providing complex information reduced the amount of information provided, but did not improve patient recall rate. TRIAL REGISTRATION NUMBER: ISRCTN42739508.