Medical pedagogy

Empower patients to make engaged and well-informed shared decisions on MS treatment

Patients’ understanding of their disease and their engagement in their care and disease are particularly important in complex and chronic diseases such as MS. Newly diagnosed MS patients must be involved in decisions that may decisively affect their life situation for years ahead. New effective treatments can significantly impede the progression of MS and increase the patients’ quality of life. But all treatment options have downsides with potential side effects of varying severity. It is therefore of vital importance that clinical benefits and their relationship to the probability of side-effects are taken into account and considered, not only by the clinicians but also by the patients.(1)

Patient engagement has been shown to (e. g. treatment):

  • Improve clinical outcomes
  • Reduce healthcare consumption
  • Improve service quality(1)

Pre-understanding (knowledge)
Pre-understanding (knowledge) is built on your patients’ emotional, cognitive and practical experiences and knowledge. It is the basis for interpretations of new experiences and thoughts. Patients’ interpretation of new situations or new information is always based on what they already know and their perception of the new situation. Therefore, pre-understanding is the prerequisite for all learning. But when thinking gets obstructed by preconceptions, it can be a barrier for understanding and learning. Hence, it is of vital importance to find out the patient’s pre-understanding early on in the learning process and to adapt the information accordingly.(2)

Ask the patient to tell their side of the story.
Ask them what they already know.
Let them ask questions.
Try to understand how they look at the current situation.
What are their fears, hopes and expectations?

Empowering your patients by increasing their disease knowledge and understanding is a learning process for them. Learning is always an active process. You cannot expect an optimal learning outcome by just telling. The patient must be engaged and active. One way of achieving this is to start from the patients’ own questions. It is also beneficial to vary the learning material and let the patients take responsibility for certain parts, by providing reading material or links to information on the internet. It is also important that the patient is given the opportunity to process any new information. By processing and analyzing new and old information, a new and deeper understanding and knowledge can be constructed.(2)

A positive approach
A positive approach is crucial for effective communication between clinicians and patients. In MS it is clearly associated with patients’ engagement and their will and ability to be involved in their health decisions and management.(1)

Simple conversational and listening techniques can be helpful, e. g. sitting down during a consultation, attending to patient comfort, establishing eye contact, listening without interrupting, showing attention with nonverbal cues such as nodding, allowing silences while patients search for words, acknowledging and legitimizing feelings, explaining and reassuring during examinations, and asking explicitly if there are other areas of concern.(1)

Empowering patients requires changing their role from healthcare ‘receiver’ to ‘active participant’. Therefore, the role of the healthcare professional also needs to evolve from being a ‘provider’ of healthcare to become a ‘motivator’ and ‘supporter’ of patients to help them achieve this.(1)

To create motivated patients, one must understand that meaningfulness is crucial to stimulate learning. What we learn has to be important for different reasons. For a MS patient it might be meaningful to understand how their treatment works and why they might experience side-effects. In patients with chronic diseases motivation often comes naturally because of their situation, although some might repress their thoughts on their situation. Try to find ways to stimulate their will to learn. Learning must also be demanding and fun.(2)

To give and receive feedback is an important part of the learning process. It is a two-way process where patients are allowed to both express their needs and thoughts as well as a way of getting an idea of how much they have understood.(2)


1. Rieckmann P, Boyko A, Centonze D et al. Mult Scler Relat Disord 2015;4:202–218
2. Silén, C., Bolander Laksov, K. (ed) (2013) Att skapa pedagogiska möten i medicin och vård. Lund: Studentlitteratur. (For internal review, reference in English refer to document: Supplementary Appendix.)



Biogen-13606 februari 2023
Senast uppdaterad: 2023-02-13