April 16, 2021 – by Gianna Melillo
An online tool developed to facilitate efficient patient-provider decisions on disease modifying drugs for multiple sclerosis (MS) ran into several challenges and warrants further study.
Researchers in the Netherlands developed a prototype of an online patient decision aid tool for individuals with multiple sclerosis (MS) to assist in decision-making about treatment with disease-modifying drugs (DMDs). The tool, based on the principles of multicriteria decision analysis (MCDA), was developed following recommendations of the International Patient Decision Aid Standards (IPDAS).
Although some issues identified in the prototype were resolved, additional issues remained, according to study findings published in BMC Medical Informatics and Decision Making. Overall, “further development is needed to overcome these issues before beta pilot testing with patients and health care professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, health care professionals, and the quality of care,” the researchers wrote.
Because decision-making about treatment with DMDs for MS is preference sensitive—in that it requires a trade-off between treatment benefits and burden—shared decision-making between patients and health care professionals ought to take place, the authors explained. In particular, patients with relapsing-remitting MS (RRMS) and those with diagnosed clinically isolated syndrome (CIS) often have to decide whether to begin treatment with DMDs, which can delay or prevent an accumulation of disabilities wrought by the disease.
“The large number of treatment options and the uncertainties associated with the options in terms of effects complicate the decision-making for health care professionals,” the authors said, while for those with MS, “the decision to start with a DMD can be even more difficult due to the cognitive and mental symptoms many patients experience.”
The researchers’ patient decision aid encompassed the principles of a user-centered design and consisted of 6 stages: scope of the patient decision aid, assessment of decisional needs, format, review and synthesis of evidence, development of prototype, and alpha pilot testing.
The aid included all brand name and generic DMDs available for patients with RRMS and CIS in the Netherlands (n = 12) and an option for no drug treatment. A total of 19 patients with RRMS identified important characteristics of DMDs with regard to decision-making on treatment via focus groups. Of the 34 attributes identified, 27 were included in a best-worst scaling survey administered to 185 patients, 27 neurologists and 33 MS nurses.
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