In the latest in a series of blogs from TiMS (Therapists in MS), Clinical Specialist Physiotherapist Lynn Watson from the Swansea Neuro Inflammatory Service describes how their team participated in a pilot study aimed at getting the most out of annual reviews with patients by using the MS Self-Reported Assessment Tool. The intention of the Assessment Tool is to provide a means by which the person with MS is central to the process by enabling them to identify and prioritise their symptoms and care management.
We all pride ourselves in tailoring annual reviews to individuals. Ranging from those who have lists of questions prepared, to those who are very chatty and perhaps more challenging, those who say very little. Some people wait until the very end to raise something very important to them, leaving you feeling pressured by time. You may also have a feeling something was left unsaid or you receive occasional phone calls the following day where someone rings with what they had forgotten to ask.
It can be a challenge to ensure that a consultation is patient-centred whilst striving to ensure that all relevant aspects of MS are discussed as recommended in the 2014 NICE MS Guidelines. As a team we have explored different strategies with co-production principles at the heart of our ethos. The MS Self-Reported Assessment Tool provides an excellent opportunity to allow patients to complete a comprehensive questionnaire regarding their symptoms and also to complete their medication details. Then, perhaps most importantly they are able to indicate which they want to discuss as a priority.
We were delighted to be one of the pilot sites for this tool and it was easy to implement within our existing service for the six-week period. We decided to give some in clinic waiting areas for patients to complete immediately before their appointment but where timescales allowed they were sent out with their appointment letter. The latter we felt gave more time for patients to consider their responses and led to the medication section being fully completed, but inevitably some were not returned as they were forgotten. For those completed in the waiting area there was a 100% completion rate and everyone was happy to be part of the trial.
The feedback from patients included "it made me think about my symptoms, so instead of saying ‘I’m fine’, I was more honest about my symptoms". Another patient said "it was a good prompt for clinic as it was my first review appointment I wasn’t sure what may be asked, or what I could ask about". One patient welcomed the inclusion of sensitive questions, specifically sexual function. She completed it with her husband and it led them to have a discussion about her symptoms that were then raised in the consultation and they were pleased this could be addressed.
The Assessment Tool took only a few minutes to complete, it was easy to review in clinic and formed part of the documentation. It was particularly useful to identify the symptoms that were new and therefore to identify anything that may be a higher priority from our point of view that could be an unreported relapse or an unexpected change.
Our team feel this could be a valuable tool to ensure that our patients get the most out of their annual review appointments, and to ensure discussion prioritises the issues that are important to them, whilst being confident that no issues are unreported. We look forward to the ongoing work that the TIMS Research Working group will be undertaking to explore the views of people with MS in relation to the MS Self-Reported Assessment Tool.
Further details on the pilot including other people’s views of using the MS Self-Reported Assessment Tool can be found on the poster displayed at the 2018 MS Trust Conference.