Compliance With the Care Plan

Addressing adherence challenges to an MS care plan

Long-term adherence to an overall MS care plan requires a proactive approach to assess each patient’s needs and lifestyle. In some cases, patients may be intentionally nonadherent, meaning they actively choose for a variety of reasons not to follow their care plans. In other cases, patients are unintentionally nonadherent and deviate from their care plans due to forgetfulness, carelessness or circumstances beyond their control. It is important to have a conversation to understand why they are nonadherent and how they can overcome these challenges. 38,60

Some potential challenges for staying with a care plan include:

Patient Perception of Effectiveness

Therapies don’t always offer obvious signs of improvement, so patients may doubt their effectiveness. Help your patients understand that relapses may occur, even with treatment. 61


Insurance issues or coverage gaps can make it difficult for patients to afford their treatment. Refer your patients to various organizations or resources that can provide financial support. 61

Health Literacy

Patients may not always understand the instructions they received from you or their doctors. Use short words, simple sentences and clear instructions, and verbally reinforce written instructions. 62

Cultural or Religious Differences 63

Cultural or religious circumstances can magnify the discrepancy between the views of patients and health care providers. Recognize and take into account the way the patient experiences their illness when building their care plan.

Addressing adherence challenges to MS medications

Some challenges patients with MS may face when it comes to staying adherent with their medications include:

Adherance Challenge Cause of Challenge Recommendations
Treatment fatigue 61 With chronic conditions, treatment continues throughout a person’s life Reinforce the importance of therapy for maintaining health and quality of life
Side effects 61,64 Medications for MS can have intolerable side effects that sometimes don’t improve over time Patients who are experiencing side effects should contact their doctor
Injection-related factors 61
Many disease-modifying therapies are injectable and that can pose issues for people with needle phobia and fear of injection-related reactions
Teach proper injection technique and help your patient develop relaxation techniques
Forgotten doses 61 Decreasing cognitive and physical ability can impact a person’s ability to remember and administer the sometimes complex dosing regimens Recommend a reminder system or have your patient’s family member or care partner administer the dose

Addressing adherence challenges with your patients

People with MS need to feel that their MS challenges are understood. The more a person feels supported, the more likely they will be adherent. These conversations should be open and honest and individualized to meet your patients’ needs. A person with MS should be actively listened to, reinforced in positive behavior and helped in determining an action plan. 38 You can help support them by:

  • Reinforcing the importance of adherence
  • Using open-ended questions and motivational interviewing to address treatment nonadherence
  • Using your own experiences to create a checklist to uncover treatment issues
  • Engaging support partners to find ways to help patients stay on treatment