Online Shared-Decision Making Tool, MS-SUPPORT, Shows Potential for Increasing DMT Initiation and Adherence
The online tool was evaluated in a cohort of 501 patients and healthcare providers, showing positive trends in 9 of 11 outcomes assessed. Notably, disease-modifying therapy start, adherence, and long-term mental health were all improved in the intervention group.
Nananda Col, MD, MPH, MPP
MS-SUPPORT, an online tool consisting of passages and surveys for patients with multiple sclerosis (MS), might be able to increase disease-modifying therapy (DMT) initiation as well as improve adherence to treatment and long-term mental health. The results of this study, conducted by Nananda Col, MD, MPH, MPP, and colleagues, showed positive trends for 9 of 11 outcomes, establishing the feasibility of implementing the tool in practice.1
Col, the founder of Shared Decision Making Resources, in Georgetown, Maine, and colleagues assessed the tool at 34 sites among adults with relapsing MS and referring healthcare providers who specialize in MS, which included neurologists, physicians’ assistants, registered nurses, and nurse practitioners. All of the screening, consent, intervention use, and follow-up was performed online. Col presented the data in a poster at the 2022 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, June 1-4, in National Harbor, Maryland.
In total, the cohort included 501 individuals, 262 of which in the intervention group (203 completed the tool’s preclinic survey, defined as time point 1), and 239 in the control group. In the intervention group, 94 shared the report with their healthcare provider at their clinic visit. At time point 2, the post-clinic visit survey, 192 patients and 108 providers in the intervention group completed evaluations, while 201 patients and 109 providers did so in the control group.
The rates of current DMT use were consistently higher in the MS-SUPPORT intervention group (1.30; 95% CI, 0.86-1.96) compared with the control group, with a shorter median to start treatment time of 46 days compared with 90 days (P = .24). Additionally, perfect adherence to daily DMT use was higher for those in the intervention group at the post-clinic visit time point (intervention: 81.26%; control: 56.41%; P =.026), and fewer patients in the intervention group forgot to take medications (P = .046).
Notably, mental health, measured by quality of life with the 4-item Healthy Days Module, was better in the intervention group compared with the control group at 6 and 12 months (P = .02).
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“Clinical guidelines recommend incorporating patient preferences into decisions about DMTs for MS to improve acceptance and adherence to DMTs,” Col and colleagues wrote, adding that, “guidance is lacking on how to accomplish this with [more than] 23 DMTs available and limited head-to-head comparisons.”
The mean age of patients was 48.1 years (SD, 11.4) and 48.7 years (SD, 11.9) in the intervention and control groups, respectively, with similar rates of the proportion of women, education level, type of MS (>91% relapsing MS), duration of disease, and DMT use. DMT utilization was defined as the self-reported start, continue, switch, or stop of DMT; and time-to-start treatment. Adherence was reported as the number of doses missed during the prior month.
The majority of the patients, 88.2%, reported that they would recommend the use of MS-SUPPORT, and more healthcare providers reported excellent communication domains. There were also no differences between the groups with regard to the efficiency of their clinic visits, with both the intervention and control groups reporting “excellent” visits at rates of 77% and 78%, respectively.
The MS-SUPPORT tool was developed via a systematic, patient-centered process with the goal of assessing patient goals and preferences, in order to “fill key knowledge gaps, misconceptions, and barriers to shared decision-making,” the investigators wrote. The tool is also able to generate personalized reports that can be shared with clinicians via email or patient portal, or printed out.
There were some limitations acknowledged by the investigators, namely that the improvements over time in the control group, coupled with high baseline scores, suggest that there may have been response and selection biases. As well, the COVID-19 pandemic affected logistics, access to DMTs, and variability for both patients and providers, which reduced Col et al’s power to detect an effect. The next steps, they wrote, are to “explore dissemination approaches and adding reinforcements, while monitoring implementation in real-world settings to provide further insights into the value and utility of this new type of [shared decision-making] tool.”
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