Shared Decision Making in Multiple Sclerosis: Option Grid (OG) Point of Care Engagement Tools (POCETs) for Dmt Treatment (Work in Progress)

Background: There has been a dramatic increase in FDA-approved disease modifying treatment (DMT) options for multiple sclerosis (MS) over the past decade.  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 all MS patients, making DMT decisions highly preference sensitive for patients and providers.  Decision support is indicated in preference sensitive decisions and can improve decision quality, but no comprehensive, easy to use, and current decision aid currently exists for DMTs in MS.  One novel type of concise yet comprehensive decision support tool is called an Option Grid (OG).  OGs can be used in clinical encounters to improve the quality of DMT treatment decisions using a shared decision-making approach. 

Objectives: To develop two evidence-based, peer-reviewed, and patient-advised OGs for DMTs in RRMS, one for injectable and infusible DMTs, and one for oral DMTs.   

Methods: We are developing OGs for DMTs in RRMS using a four-part process featuring a balanced, multiple stakeholder approach.  The four-component process includes an evidence synthesis of DMTs, an assessment of the OGs by an expert panel of MS clinicians and scientists, commentary by shared decision making and decision science experts, and feedback from MS patients obtained through focus groups.  The OG designs will follow standard OG format (see www.optiongrid.co.uk) which consist of one-page tables providing concise information on DMTs categorized by frequently asked questions (FAQs) that are of high interest and relevance to patients facing DMT treatment decisions.  Prototype OGs will be subjected to reviews by the Option Grid Collaborative (shared decision making experts), a panel of MS clinician and research experts, and NMSS patient advisory groups for review.  We will incorporate feedback from these groups into the final OG versions.  Once the OGs are finalized, they will be published on the Option Grid Collaborative website where they will be freely available in the public domain (http://www.optiongrid.org/optiongrids.php). 

Results: This is a work in progress initiated in Summer 2012, with anticipated completion by Fall 2014.  A progress report, including prototype OGs, and a summary of initial peer reviews, will be available for presentation at the 2014 CMSC conference.

Conclusions: Evidence-based, peer-reviewed, and patient-advised OGs for DMTs in RRMS can be incorporated in the clinical setting in a shared decision-making approach and have the potential to improve DMT decision quality and treatment adherence.