Adherence to disease modifying therapies (DMTs) in multiple sclerosis: a thematic meta-synthesis of qualitative research

Abstract

Up to 59% of people with multiple sclerosis (MS) are sub-optimally adherent to disease modifying therapies (DMTs), leading to relapses and hospitalization. The aim of this review is to systematically identify, appraise and synthesise qualitative research exploring views and experiences of people with MS regarding DMTs, to identify factors potentially influencing treatment adherence. Systematic searches of six databases and citation searching identified 1326 unique citations. Screening by two reviewers yielded 12 studies for inclusion. These were appraised using the Critical Appraisal Skills Programme tool and synthesised thematically. Included papers dated from 2001-2014, reporting studies conducted in the USA (n=8), Canada (n=3) and the UK (n=1). The majority focused on experience of self-injecting DMTs, though one study examined only intravenous infusions and four additionally considered oral therapies. Synthesis generated higher-order analytical themes leading to broader conceptual understandings than presented within individual studies. Themes encompassed the importance of feeling in control; the desire to lead a normal life and the extent to which DMTs facilitated or inhibited this; and the continual process of weighing up costs and benefits of treatment (including adverse side effects and perceived effectiveness) to achieve optimal quality of life now and in the future. People with MS take DMTs when they believe the drugs will facilitate their living a ‘normal’ life, and avoid taking them when they believe they will interfere with quality of life or present risks. Future research should investigate adherence to oral and intravenous DMTs, and interventions should address these patient objectives.