The Importance of Shared Decision-making and Goal Setting in Patients With Myasthenia Gravis


Ericka Wong, MD, discusses the importance of shared decision-making and goal setting when treating a patient with myasthenia gravis.

Ericka Wong, MD: When I’m talking to patients about treatment, I involve them in the decision-making. I want them to understand why I’m prescribing a medication and what it’s for. For example, I explain that pyridostigmine is symptomatic and lasts for several hours and that’s why you have to take it multiple times a day vs if they’re on azathioprine. That suppresses the immune system and will treat the underlying disease, but it takes a much longer time to take effect. That may be why they’re on steroids. I’ll explain, and it’s important to counsel the patients why they’re on a medication and the expectations of that medication in terms of when it will be effective. That helps with compliance as well.

Beyond that, the impact of myasthenia on their quality of life is really important. One thing I often ask patients is what’s important to them and what would make the biggest difference in their lives in terms of treatment. You can have mild myasthenia, for example, if a patient has double vision without weakness. But obviously, double vision can be very functionally impairing. They can’t drive, or it might prohibit them from doing things at work. Even though it’s considered a mild version of myasthenia, the impact on their life is great. I take that into consideration as well when we’re choosing medications to treat them.

The aim of treatment for myasthenia gravis should be remission or only mild symptoms. That’s the goal. I want to get them to a point where they don’t have to think about their disease burden day to day. That’s not possible in all patients, but for many patients, that’s possible with myasthenia. I pretty much always involve them in the decision-making. I want to know what they think is an acceptable outcome and what they think is tolerable in terms of side effects. That helps us choose what therapy might be best suited for them.

Transcript Edited for Clarity

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