Shared Decision Making for Multiple Sclerosis: Developing a Decision Aid For DMTs

Background:  In recent years there has been a dramatic increase in FDA-approved disease modifying treatment (DMT) options for multiple sclerosis (MS).  Current DMTs vary greatly in efficacy, administration, monitoring, tolerability, and adverse effects.  No single DMT has yet been identified as the optimal effective care treatment for MS, making DMT decisions highly preference sensitive for patients and providers.  Preference sensitive decisions are characterized by the presence of a number of clinically reasonable options with varying risks and benefits and require a balanced consideration of knowledge, values, and preferences to produce optimal decision quality.  High quality treatment decisions can improve patient satisfaction and treatment adherence, which can contribute to improved clinical outcomes.  Decision aids (DAs) have been shown to improve decision quality and Option Grids (OGs) are recognized as a novel DA.  Currently, no DAs exist for DMTs in MS.

Objectives:  We will develop evidence-based, peer-reviewed, and patient-advised OGs for MS DMTs (MSOGs). 

Methods: MSOG design will follow standard OG format (see www.optiongrid.co.uk) and will consist of a one page table providing concise information on DMTs categorized by frequently asked questions (FAQs) that are of high interest and relevance to patients facing DMT treatment decisions.  Selection of FAQs will be guided by available literature and patient advisement through two semi-structured qualitative focus groups.  Initial development of MSOGs will be driven by a comprehensive evidence synthesis based upon available randomized controlled trials and meta-analyses of FDA-approved DMTs.  Draft MSOGs will then be peer reviewed by a consensus panel of physician and nurse MS specialists representing clinical, academic, and research perspectives.  Technical advisement on OG design and shared decision making aspects will be provided by experts from the Dartmouth Center for Healthcare Delivery Science and Massachusetts General Hospital.    

Results: This is a work in progress initiated in Summer 2012, with anticipated completion by Summer 2013.  An initial progress report, including prototype MSOGs will be available for presentation at the 2013 CMSC conference.

Conclusions: Evidence-based, peer-reviewed, and patient-advised MSOGs have the potential to improve DMT decision quality, treatment adherence and related MS clinical outcomes.