Multiple Sclerosis Treatment Decision-Making With MS-SUPPORT Tool

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Nananda Col, MD, MPH, MPP, FACP, the president and founder of Shared Decision Making Resources, spoke about usage of the MS-SUPPORT tool in a recent study to foster shared decision-making between patients and clinicians in multiple sclerosis.

Nananda Col, MD, MPH, MPP, FACP, the president and founder of Shared Decision Making Resources

Nananda Col, MD, MPH, MPP, FACP

Credit: Shared Decision Making Resources

MS-SUPPORT is an online, interactive, evidence-based shared-making decision assistant cocreated with patients with multiple sclerosis (MS). This tool helps clarify patient treatment goals and values and provides personalized information about MS, disease modifying treatments (DMTs), and adherence. MS-SUPPORT produces a personalized summary of the gathered informational components and clinical status of the patient with MS which can be shared with their clinician during a visit.

A recent randomized controlled trial (NCT04122989) assessing MS-SUPPORT showed increased short-term probability of taking and adhering to DMTs, as well as improved long-term mental health in patients with MS.1 The trial compared MS-SUPPORT with usual care given to the patients over a 12-month period. Investigators enrolled 501 English-speaking adult patients with relapsing MS and MS clinicians were invited to participate to share their clinical perspectives, which were also evaluated by the researchers.

Lead author Nananda Col, MD, MPH, MPP, FACP, president and founder of Shared Decision Making Resources, had a conversation with NeurologyLive® to discuss how DMTs for MS are currently available, and why choosing the most optimal therapy may be a challenge for patients. She also talked about the key benefits observed in patients who used the MS-SUPPORT tool compared as well as how the tool contributes to promoting shared decision-making between patients and clinicians.

NeurologyLive: What were the main findings of the study? Did you find anything surprising?

Before talking about our findings, it’s important to mention that decisions about managing MS are incredibly difficult. Scientific advances have resulted in over 21 different powerful disease modifying medications that can slow the course of MS. But choosing amongst them can be daunting. Clinicians are supposed to factor in patient preferences and values when choosing treatment, but that turns out to be really hard to do. It can also be difficult for patients to sort out what matters to them when faced with such complex options, let alone sharing those preferences and values with their clinicians.

Top Clinical Takeaways

  • MS-SUPPORT facilitates informed decision-making, with patients more likely to initiate and adhere to treatments.
  • The collaboration with the MS Association of America aims to make the MS-SUPPORT tool freely accessible.
  • The study highlights the tool's potential to enhance patient understanding, promote shared decision-making, and positively impact treatment outcomes.

To help patients make better decisions about treatment, that is, decisions that reflect their informed values, we developed a tool that is designed to promote shared decision making between patients and their clinicians. Patients interact with the tool, MS-SUPPORT, online (it takes about 20-30 minutes), learning about MS and their options, with a focus on helping patients uncover or clarify their own values and preferences. The tool then generates a short executive summary of the patient’s goals and preferences that can be shared with their clinician. Our study formally tested this new tool on over 500 patients with MS and their clinicians, from across the US, following them for one year.

Our main finding was that this novel tool was strongly endorsed by patients and their clinicians and helped them make better decisions about treatment. Patients who used the tool (compared to those who didn’t) were more likely to start a treatment, to start it earlier (which is really important, because treatments are more effective when started earlier) and to take it as prescribed. And surprisingly, we found that patients who used MS-SUPPORT reported a better quality of life with respect to their mental health than those who were randomized to not using the tool. The differences were clinically and statistically significant in the short-term and long-term.

What are the implications of these results for patients with MS?

The most important implication is that this new tool, MS-SUPPORT, can help patients better understand their MS, their treatment options, and help them be more meaningfully involved in decisions about their health. For clinicians, this tool can help them practice shared decision making, which is strongly recommended by clinical guidelines. This, in turn, promotes shared decision-making, leads to improved utilization of disease modifying treatments (earlier initiation, improved adherence), and improved mental health.

What should be further investigated in this area of study?

Having demonstrated the benefits of the MS-SUPPORT tool on patients and clinicians, we are now focusing of ways to get the tool into the hands of patients and their clinicians. We are now partnering with a leading patient advocacy group, the MS Association of America (MSAA), to make the tool freely available to patients with MS. We will be collecting feedback as we do this so that we can continually improve the tool. We are open to any collaborations that can help us disseminate the tool to patients. We are also receptive to adaptations or improvements that would further enhance the effectiveness of the tool.

Transcript edited for clarity.

REFERENCES
1. Col NF, Solomon AJ, Alvarez E, et al. Implementing Shared Decision-Making for Multiple Sclerosis: The MS-SUPPORT Tool. Mult Scler Relat Disord. 2023;80:105092. doi:10.1016/j.msard.2023.105092
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