Shared Decision-Making Intervention MS-SUPPORT Provides Several Benefits to Patients With MS

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An online shared decision-making tool showed feasibility in most patients with multiple sclerosis, with reported improvements in understanding treatment options and adherence to treatment.

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

Nananda Col, MD, MPH, MPP, FACP

A randomized controlled trial (NCT04122989) assessing a shared decision-making (SDM) intervention called MS-SUPPORT showed increased short-term probability of taking and adhering to disease modifying treatments (DMTs), as well as improved long-term mental health in patients with multiple sclerosis (MS).1 These findings support the feasibility of MS-SUPPORT in clinical practice as a means to improve treatment adherence and quality of life in patients with MS.

Among 203 patients with MS who completed using the tool, 88.2% (n = 178) reported they would recommend it to others and 85.2% said it helped them talk to their clinician. In addition, 82.3% of users reported that it helped them understand their options and 82.3% said it helped them understand the importance of taking DMTs as prescribed. In 222 responses from 34 clinicians who participated (neurologists, 47%; nurse practitioners, 41%; physician assistants, 12%) more clinicians in the MS-SUPPORT group (n = 108) trended towards recommending their patient start a DMT compared with the control (8% vs 5%, respectively, P = .26).

Top Clinical Takeaways

  • MS-SUPPORT showcased potential benefits by improving treatment adherence, initiating DMTs, and positively impacting the mental health of patients with MS.
  • The study's findings emphasize the feasibility and acceptability of MS-SUPPORT, with high recommendation rates from patients and trends favoring clinician recommendations for DMT initiation.
  • Despite limitations, the overall impact of MS-SUPPORT on shared decision-making processes, adherence, and mental health outcomes suggests its valuable contribution to MS care.

“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 were more likely to start a treatment, to start it earlier and to take it as prescribed,” lead author Nananda Col, MD, MPH, MPP, FACP, the president and founder of Shared Decision Making Resources, told NeurologyLive®. "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."

READ MORE: Sleep Apnea in Multiple Sclerosis May Facilitate Cognitive Decline

This trial compared MS-SUPPORT with usual care, considered a control, given to the patients over a 12-month period. Investigators enrolled 501 English-speaking adult patients with relapsing MS who had an upcoming MS appointment and an email address (women, 84.6%; white, 83%). MS clinicians were invited to participate to share their clinical perspectives, which were also evaluated by the researchers. Between November 11, 2019, and October 23, 2020, patients were referred by their clinician or a patient advocacy organization like the Multiple Sclerosis Association of America. The researchers assessed outcomes including DMT utilization, adherence, quality-of-life, and SDM at enrollment, post-MS-SUPPORT, post-appointment, and quarterly for 1 year.

Among those who weren’t on DMTs at baseline, investigators observed a trend of a higher probability ratio of current DMT use in the MS-SUPPORT group after 1-year follow-up (1.30; 0.86-1.96). In the same patient group, authors observed a trend of a cumulative higher probability of starting a DMT in 6 months, with shorter time-to-start (46 vs 90 days; P = .24). Notably, adherence to daily-dosed DMTs was higher in the MS-SUPPORT group (81.25% vs 56.41%; P = .026) compared with the control, and fewer patients forgot their doses (P = .046). Additionally, patients in the MS-SUPPORT group reported 1.7 fewer days/month of poor mental health compared with the control (P = .02).

“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," Col told. "This, in turn, promotes shared decision-making, leads to improved utilization of disease modifying treatments, and improved mental health."

MS-SUPPORT is an online, interactive, evidence-based decision assistant cocreated with patients with MS. The tool helps to clarify patient treatment goals and values and provides personalized information about MS, DMTs, and adherence. MS-SUPPORT generates a personalized summary of the collected components and clinical status of the patient which can be shared with the patient’s clinician at an appointment.

All told, the lockdown of the COVID-19 pandemic might have impacted retention and delivery of summary reports of the patients to clinicians. Authors also noted that the clinicians who referred half of the participants likely had strong SDM skills before the study. The behaviors of the participants might have changed in response to knowing they were in observation by their own clinicians which may have produced bias.2,3 Investigators observed that noncompleters of MS-SUPPORT tended to be less educated with lower health literacy, which made them suggest that MS-SUPPORT may not be appropriate for all patients with MS.

“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, to make the tool freely available to patients with MS," Col added. "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."

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
2. McCambridge J, de Bruin M, Witton J. The effects of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS One. 2012;7(6):e39116. doi:10.1371/journal.pone.0039116
3. Wunderlich T, Cooper G, Divine G, et al. Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening. Patient Educ Couns. 2010;80(3):358-363. doi:10.1016/j.pec.2010.06.034
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