Shared Decision Making in Multiple Sclerosis: Lessons Learned from Creating New Dmt Option Grid Decision Support Tools

Background: Option Grids (OGs) are a type of online, concise decision support presented in a one-page grid format. They are developed using a bounded-rationality approach and are evidence-based, peer-reviewed, and patient-advised. OGs are used for preference-sensitive decisions in a shared decision-making approach in the clinical setting. No single disease-modifying therapy (DMT) has yet been identified as the optimal effective care treatment for all multiple sclerosis (MS) patients, making DMT decisions highly preference-sensitive. We recently created two OGs for DMTs in MS. 

Objectives: To describe the lessons learned during development of the OGs for DMT treatment in MS. 

Methods: The OGs were developed using a four-part process which included evidence synthesis of DMTs, review of OGs by an expert panel of MS clinicians and scientists, feedback from patient focus groups, and commentary by shared decision-making and decision science experts. In order to present a fair and equal comparison of options across all agents, decisions had to be made in terms of the chosen clinical studies (such as time frame, quality of study, and clinical outcomes) and content of options. To comply with the one-page format and sixth grade reading level that OGs use, editing decisions were made in terms of the presentation of data. The evidence document accompanying each OG transparently describes the criteria used to generate the information about each option.

Results: Development of the OGs was initiated in Summer 2012, with anticipated publication by Spring 2014 on the Option Grid Collaborative website, where they will be freely available in the public domain at http://www.optiongrid.org/optiongrids.php. Challenges during the development and editing process regarding selection of studies, content, and presentation of data were met and resolved. Specific challenges encountered included tradeoffs between specificity and usability, brevity and exhaustiveness, detail and compliance with bounded rationality approach.  Peer review and patient focus group feedback suggest that the OGs will be practical, feasible to use, and helpful to patients and caregivers. 

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 increase patient empowerment and decision quality in DMT treatment decisions. Clinical testing will follow to explore the effects of OGs on DMT decision quality and treatment adherence.