PND79 SHARED DECISION MAKING AND USE OF DECISION AIDS IN MULTIPLE SCLEROSIS

Abstract

Decision aids (DAs) are used to facilitate patient participation and help make informed therapeutic decisions. With an ever-increasing number of treatments available for patients with multiple sclerosis (MS), there is a need to understand the effect of shared decision-making (SDM) between patients and neurologists. The study objectives were to conduct a systematic review to identify DAs utilized in MS and explore their impact on SDM. A systematic literature review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search identified English-language articles from PubMed, CINAHL, and PsycINFO databases. Review articles, thesis/dissertations, editorials, case studies, pediatric studies, and studies including patients with cognitive impairment or disabilities were excluded from the review. A total of 53 articles were identified, of which 11 studies were accepted for review based on the inclusion/exclusion criteria. All but one study was conducted outside of the United States, with majority 8 (73%) conducted in Germany. Among the 11 studies, 6 studies (54%) focused on the use of DAs and assessed outcomes such as patient preferences, understanding, knowledge, and disease management. A variety of DA formats were utilized, including educational program (1; 16%), printed materials (3; 50%), graphic format (1; 16%), and a software program (1; 16%). The DA’s utilized as printed material included a range of 6, 12, and 30 items each whereas the educational program was a 4-hour session. The web-based DA covered 3 domains and included figures demonstrating treatment effects and risks. Although a variety of DAs have been identified in MS, a need for a robust tool exists. By inappropriately assuming the patient’s scientific understanding, no current tool has extensively explored the patient’s outlook towards different treatments. Currently, a tool including both the patient’s willingness to participate and understanding of treatment options does not exist.