Managing MS in Millennials

November 26, 2020
Madison Hansen

NeurologyLive, November 2020, Volume 3, Issue 6

Effectively navigating the nuances of this unique patient population will ultimately help drive innovative solutions for this generation and those to come.

The onset of multiple sclerosis (MS) is commonly seen between age 20 and 40 years, making the millennial generation (aged 24-39 years in 2020) the most likely generation to develop MS in the coming years. As a cohort, millennials manage their health differently from the generations before them and thus will value and expect different things when it comes to their MS care. Furthermore, these differences may create new challenges for the health care team. Current MS practice must adapt to engage this unique generation and create innovative solutions tailored to their specific needs and desires. Doing so could afford this generation better prognostic outcomes as a result of increased engagement and disease management.

Shared Decision-Making

The defining quality of the millennial generation is their use of technology, although some may describe it as a dependence. Millennials are digital natives, meaning they are the first generation to grow up with the internet, and they integrate technology throughout multiple aspects of their everyday lives. Ninety-three percent of millennials own a smartphone, and nearly 100% use the internet.1 Furthermore, the millennial generation is the most educated generation yet, with 36% of millennial women and 29% of millennial men holding at least a bachelor’s degree as of 2017.2

Their education and tech savviness enable millennials to leverage technology to better manage their health. In fact, 55% of millennials said they believed health-related information on the internet is as reliable as information from medical professionals, more than any other generation.3 Providers should value this personal motivation to seek out health information and continue to encourage patients’ self-learning. The advantages of easily accessing a multitude of information from a wide variety of sources on the internet, however, must be balanced with an understanding of the differing degrees of validity between sources. Less than half of millennials were concerned with finding false or misleading health data on the internet, the lowest percentage among all generations.3 Pointing patients toward trusted sources of information is an important first step to help encourage a credible knowledge source for these patients and to create a shared knowledge base between patient and provider. Equipping millennial patients in this way will emphasize their autonomy and facilitate shared decision-making between the patient and provider.

Building Trust to Enhance Patient Counseling

Current trends demonstrate an overall lack of trust in medical doctors by millennials; less than half of millennials were very satisfied with information from their doctor.3 Additionally, millennials were the least likely generation to respond, “I always listen to my doctor(s)” compared with other generations. Medical providers can build trust by understanding the communication strategies that millennials prefer.

As digital natives, millennials expect easy accessibility, rapid turn-around, and direct communication.4 Easy online appointment scheduling, short wait times, and online patient portals where patients can access their results and communicate directly with providers are examples of baseline logistics that health care providers can implement to start off on the right foot with their millennial patients. Millennials also value medical information directly from their peers: 4 out of 10 millennials trust their peers more than they trust medical professionals when it comes to their health.3 Providers can build off this heightened trust in social circles by utilizing young adult patient support groups to allow millennial patients with MS to share their experiences and learn from their peers. Highly versed in social media platforms, this generation could transform patient advocacy both locally and globally.

Using social media as a way to engage millennial patients with MS can be effective if done correctly. Millennials do, however, have a healthy dose of skepticism when it comes to health information on social media specifically. While 67% of Americans reported seeing health information on social media, only 35% said the information was even “mostly accurate.”3 Curated social media content from providers and clinics should emphasize the validity of the content by referencing studies, citing a trusted school or research organization, or including explanations directly from a medical professional. Consistency in communication style and content is key to bridging the gap between millennial patients and health care providers.

It would be a disservice to all patients not to note the complex impact of race on mistrust in the medical profession specifically.5 Ramifications from historic unjust medical practices continue to influence current medical practice, exemplified by the decreased participation in clinical trials by minorities due to the influence of the US Public Health Service Syphilis Study at Tuskegee (commonly known as the Tuskegee Syphilis Study).6 Because the millennial generation is the most diverse population in America, with minorities making up almost half of the population,2 mistrust in medical providers and medical institutions may be heightened within the millennial cohort. It is imperative for providers to understand the history of racism in American medicine and the complex ways in which it influences patients today. Establishing a shared understanding of these health injustices with millennial patients can help rebuild trust one patient at a time.

Cost Considerations

Millennials are the most cost-conscious generation yet, and understandably so; millennials have higher levels of student loan debt, poverty, and unemployment rates than the 2 previous generations— Generation X and baby boomers—had at the same stage of their life cycles.7 This economic strain leads millennials to often cut corners when it comes to their health care, a dangerous trend when diagnosed with a chronic, progressive disease like MS. More than half of millennials admit to delaying or avoiding medical treatment due to cost.8 It is well known that the cost of MS care is substantial, and MS-specific health care costs have been shown to increase with disease severity. Those with mild to moderate disease severity spent an average of $30,000 on health care costs per year compared with $100,000 per year for those with severe disability.9 Therefore, a key strategy to decreasing overall costs for millennial patients is emphasizing disease prevention. For example, although disease-modifying therapies (DMTs) often account for the majority of MS-related health care costs due to their high price tags, an effective DMT is a patient’s best resource for preventing the frequency and severity of relapses and for slowing disease progression. Emphasizing the cost-saving strategy of disease prevention from the day of diagnosis is important to encourage millennials with MS to invest in their health care. As
new DMTs continue to be developed, often with greater efficacy at the expense of higher costs, it is imperative for providers to navigate costs with millennial patients when making treatment decisions. Treatment plans need to be individualized and align with each patient’s unique values and goals, as well as financial feasibility. These cost conversations should be initiated by providers to demonstrate a common understanding of the immense financial burden that an MS diagnosis entails. There is also a clear, increased need for financial advisers within MS practices to help millennial patients financially plan for lifelong MS health care costs.

Focus on Mental and Behavioral Health

Millennials report the worst mental and behavioral health outcomes compared to any prior generation.10 Compounding these trends is the increased prevalence of mental health disorders among the MS population in general. Patients with MS are 3 times more likely to experience anxiety or depression compared with the general population.11 Furthermore, inequity in mental and behavioral health prevalence has been seen among different demographics. In a survey of 1500 individuals, people who identify as LGBTQ+ were 3 times more likely to experience a mental health condition. Black and Hispanic respondents were more likely to experience every mental and behavior symptom assessed in the study compared with the study population as a whole.12

Because millennials are the most diverse generation to date, MS providers should understand the increased burden of mental health on this generation as well as the unique experience of specific millennial demographics. Increased collaboration with mental health providers is imperative to providing quality MS care to millennial patients. Incorporating standardized depression and anxiety assessments into clinic workflow can equip providers to track mental health outcomes in their patient populations over time and serve as a launching point for provider-initiated conversations about mental health. Quality MS care must not only treat this unpredictable disease, but also adequately address the multiple disease sequelae experienced by patients, including mental and behavioral health.

Conclusions

Millennials are a technologically savvy, cost-conscious, diverse, and educated population who experience unique financial and mental health burdens compared with previous generations. Their distinctive characteristics drive change across multiple different sectors, including health care, and these changes create ripple effects across all generations. For example, millennial demand for technology has led Generation X and baby boomers to increasingly adopt technological platforms in their own lives.1 Early analysis of the youngest generation, Generation Z (those born after 1996), signal similar preferences to millennials, only heightened.13 MS care not only needs to adapt to better serve millennial patients with MS, but to adequately serve
all generations past, present, and future. Innovative solutions geared specifically toward millennials will allow for increased patient engagement now and in the years to come.

References
1. Vogels EA. Millennials stand out for their technology use, but older generations also embrace digital life. Pew Research Center. September 9, 2019. Accessed October 12, 2020. https://www.pewresearch.org/fact-tank/2019/09/09/us-generations-technology-use/ 
2. Fry R, Igielnik R, Patten E. How millennials today compare with their grandparents 50 years ago. Pew Research Center. March 16, 2018. Accessed October 13, 2020. https://www.pewresearch.org/fact-tank/2018/03/16/how-millennials-compare-with-their-grandparents 
3. Weber Shandwick and KRC Research. The great American search for healthcare information. November 13, 2018. Accessed October 12, 2020. https://www.webershandwick.com/wp-content/uploads/2018/11/Healthcare-Info-Search-Report.pdf 
4. Waljee JF, Chopra V, Saint S. Mentoring millennials. JAMA. 2020;323(17):1716-1717. doi:10.1001/jama.2020.3085
5. Sullivan LS. Trust, risk, and race in American medicine. Hastings Cent Rep. 2020;50(1):18-26. doi:10.1002/hast.1080
6. Scharff DP, Mathews KJ, Jackson P, Hoffsuemmer J, Martin E, Edwards D. More than Tuskegee: understanding mistrust about research participation. J Health Care Poor Underserved. 2010;21(3):879-897. doi:10.1353/hpu.0.0323
7. Millennials in adulthood. Pew Research Center. March 7, 2014. Accessed October 13, 2020. https://www.pewsocialtrends.org/2014/03/07/millennials-in-adulthood 
8. Five ways tech-savvy millennials alter health care landscapes. News release. PNC Healthcare. March 23, 2015. Accessed October 13, 2020. https://www.prnewswire.com/news-releases/five-ways-tech-savvy-millennials-alter-health-care-landscape-300054028.html 
9. Owens GM. Economic burden of multiple sclerosis and the role of managed care organizations in multiple sclerosis management. Am J Manag Care. 2016;22(suppl 6):s151-s158.
10. APA Stress in America survey: Generation Z stressed about issues in the news but least likely to vote. News release. American Psychological Association. October 30, 2018. Accessed October 13, 2020. https://www.apa.org/news/press/releases/2018/10/generation-z-stressed 
11. Beier ML. Multiple sclerosis and mental health: 3 common challenges. Johns Hopkins Medicine. Accessed October 13, 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms/multiple-sclerosis-and-mental-health-3-common-challenges 
12. Mind Share Partners. Mental Health at Work 2019 Report. Accessed October 13, 2020. https://www.mindsharepartners.org/mentalhealthatworkreport 
13. Parker K, Igielnik R. On the cusp of adulthood and facing an uncertain future: what we know about Gen Z so far. Pew Research Center. May 14, 2020. Accessed October 13, 2020. https://www.pewsocialtrends.org/essay/on-the-cusp-of-adulthood-and-facing-an-uncertain-future-what-we-know-about-gen-z-so-far/ 
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