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Decision support tools help patients with MS more effectively engage with their providers and adhere to their treatment.
At the 2023 Fall Conference of The American Academy of Neurology, Augusto Miravalle, MD, FAAN, delivered a presentation titled “Test Your Knowledge: Multiple Sclerosis.” Among other topics, Dr. Miravalle talked about the need for better diagnostics in MS. The MS-SUPPORT Tool represents a new option for obtaining patient-reported information on disease progression in MS.
MS-SUPPORT, an online interactive, evidence-based decision aid, appears to help patients with MS more effectively engage with their providers and adhere to their treatment, researchers report in Multiple Sclerosis and Related Disorders.
Patients view the MS-SUPPORT tool before their clinic appointment. The tool generates a personalized summary of the patient’s treatment goals and preferences, adherence, disease-modifying treatment (DMT) use, and clinical situation. Patients can share the summary with their MS clinician to guide discussions and facilitate shared decision-making.
“Our study found that MS-SUPPORT helped patients participate in treatment decisions,” says lead study author and principal investigator Nananda F. Col, MD, MPH, MPP. “By following patients for a year, we found that those who used the tool used DMTs more effectively than those who did not. They were more likely to start a DMT and take it as directed earlier in the disease process. Use of the tool also improved patients’ long-term mental health quality of life.”
To compare usual care with the tool they developed, Dr. Col and colleagues conducted a randomized controlled trial in 501 English-speaking adults throughout the United States who had relapsing MS, an upcoming MS appointment, and an email address. Participants’ ages ranged from 19 to 78 (mean age, 48); 84.6% were female, and 83% were White.
MS clinicians or the Multiple Sclerosis Association of America referred patients to the study between November 2019 and October 2020. Overall, 34 MS clinicians (47% neurologists, 41% Nurse Practitioners, and 12% Physician Assistants) from 19 practices referred potential participants to the study.
The researchers randomized participants at the clinician level to MS-SUPPORT or to usual care. The researchers evaluated DMT utilization, adherence, quality of life, and shared decision-making at enrollment, after viewing MS-SUPPORT (for those in the MS-SUPPORT group), immediately post-appointment, and quarterly for one year post-appointment.
- Of the 203 patients who completed using MS-SUPPORT before their clinic visit, more than 80% reported that the tool helped them talk to their doctor, that it helped them understand their options and the importance of taking DMTs as prescribed, or that they would recommend it to others (Table).
- In the MS-SUPPORT group, 81.3% of patients had no missed daily DMT doses versus 56.4% among the controls (P=0.026). Fewer patients forgot their doses (P=0.046), and they reported 1.7 fewer days per month of poor mental health, compared with controls (P=0.02).
Shared Decision-Making Benefits Patients & Clinicians
“Use of a shared decision-making tool such as MS-SUPPORT streamlines clinic visits by helping patients prepare for their visit and by helping clinicians better understand what matters to their patients,” Dr. Col says. “Shared decision-making is a win-win proposition.”
Even though shared decision-making is essential for patient-centered care and recommended by MS clinical guidelines, Dr. Cole points out that it rarely happens. She advises patients to be aware of their treatment options and be able to tell their clinicians what matters to them so they can partner with them to find the best treatment.
“DMTs offer tremendous opportunities to improve the course of MS, especially when started early in the disease and taken as directed, but they also carry risks and inconveniences,” Dr. Col notes. “We wanted to find a way to give patients a greater voice with their clinician so they could be more meaningfully involved in decisions about treatment.”
Dr. Col acknowledges that selection bias, response bias, social desirability bias, and recall bias are limitations to the study. She and her colleagues are planning further related research and are exploring ways to make MS-SUPPORT widely accessible.
