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Bansback N, Chiu JA, Carruthers R, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Lynd LD, Traboulsee A. Development and usability testing of a patient decision aid for newly diagnosed relapsing multiple sclerosis patients. BMC Neurol 2019; 19:173. [PMID: 31325961 PMCID: PMC6642472 DOI: 10.1186/s12883-019-1382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients often struggle with treatment decisions, in part due to the increasing number of approved disease modifying therapies, each with different characteristics, and also since physicians can struggle to identify which of these characteristics matter most to each individual patient. Decision uncertainty can contribute to late treatment initiation and treatment non-adherence-causes of 'undertreatment' in MS. An interactive online patient decision aid that informs patients of their options, considers their individual preferences and goals, and facilitates conversations with their physicians, could improve how patients with relapsing forms of MS make evidence-based treatment decisions. OBJECTIVE To develop and evaluate a prototype patient decision aid (PtDA) for first-line disease modifying therapies for relapsing-remitting multiple sclerosis. METHODS Informed by previous studies and International Patient Decision Aid Standards guidelines, a prototype PtDA was developed for patients with relapsing multiple sclerosis considering first line treatment. Patients with relapsing multiple sclerosis were recruited from the University of British Columbia's Multiple Sclerosis Clinic to participate in either an online survey or a focus group. Online survey participants completed the PtDA, followed by measures of acceptability, usability, and preparedness for decision-making, and provided general feedback. Focus group participants assessed usability of the revised PtDA. The analysis of qualitative and quantitative data led to improvements of the PtDA prototype. RESULTS The prototype PtDA received high ratings for acceptability and usability, and after its use, participants reported high-levels of preparedness for decision-making. Analysis of all qualitative data identified three key themes: the need for credible information; the usefulness of the PtDA; and the importance of normalizing and sharing experiences. Nine content areas were identified for revision. Overall, participants found the PtDA to be a valuable tool for facilitating treatment decisions. CONCLUSIONS This mixed methods study has led to the development of a PtDA that can support patients with RRMS as they make treatment decisions. Future studies will assess the feasibility of implementation and the impact of the PtDA on both the timely treatment initiation and longer-term adherence.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Judy A. Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Emmanuelle Lapointe
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Alice Schabas
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | | | - Larry D. Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
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6
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Col NF, Solomon AJ, Springmann V, Garbin CP, Ionete C, Pbert L, Alvarez E, Tierman B, Hopson A, Kutz C, Berrios Morales I, Griffin C, Phillips G, Ngo LH. Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals. Med Decis Making 2018; 38:44-55. [PMID: 28806143 PMCID: PMC5929460 DOI: 10.1177/0272989x17724434] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients facing a high-stakes clinical decision are often confronted with an overwhelming array of options. High-quality decisions about treatment should reflect patients' preferences as well as their clinical characteristics. Preference-assessment instruments typically focus on pre-selected clinical outcomes and attributes chosen by the investigator. OBJECTIVE We sought to develop a patient-centered approach to elicit and compare the treatment goals of patients with multiple sclerosis (MS) and healthcare providers (HCPs). METHODS We conducted five nominal group technique (NGT) meetings to elicit and prioritize treatment goals from patients and HCPs. Five to nine participants in each group responded silently to one question about their treatment goals. Responses were shared, consolidated, and ranked to develop a prioritized list for each group. The ranked lists were combined. Goals were rated and sorted into categories. Multidimensional scaling and hierarchical cluster analysis were used to derive a visual representation, or cognitive map, of the data and to identify conceptual clusters, reflecting how frequently items were sorted into the same category. RESULTS Five NGT groups yielded 34 unique patient-generated treatment goals and 31 unique HCP-generated goals. There were differences between patients and HCPs in the goals generated and how they were clustered. Patients' goals tended to focus on the impact of specific symptoms on their day-to-day lives, whereas providers' goals focused on slowing down the course of disease progression. CONCLUSIONS Differences between the treatment goals of patients and HCPs underscore the limitations of using HCP- or investigator-identified goals. This new adaptation of cognitive mapping is a patient-centered approach that can be used to generate and organize the outcomes and attributes for values clarification exercises while minimizing investigator bias and maximizing relevance to patients.
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Affiliation(s)
- Nananda F. Col
- Nananda F. Col, Five Islands Consulting LLC, Georgetown, ME, USA; ()
| | - Andrew J. Solomon
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Vicky Springmann
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Calvin P. Garbin
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Carolina Ionete
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Lori Pbert
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Enrique Alvarez
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Brenda Tierman
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Ashli Hopson
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Christen Kutz
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Idanis Berrios Morales
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Carolyn Griffin
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Glenn Phillips
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
| | - Long H. Ngo
- />Five Islands Consulting LLC, Georgetown, ME (NFC, VS, BT, AH)
- />Neurological Sciences, University of Vermont College of Medicine, Burlington, VT (AJS)
- />Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska (CPG)
- />University of Massachusetts Medical School, Worcester, MA (LP)
- />University of Massachusetts Memorial Medical Center, Worcester, MA (LP, IBM, CPG)
- />Neurology, University of Colorado, Aurora, CO (CI, EA)
- />Colorado Springs Neurological Associates, Colorado Springs, CO (CK)
- />Biogen Inc., Weston, MA, USA, Cambridge, MA (CK, GH)
- />Harvard Medical School, Boston, MA (LPN)
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Filippini G, Del Giovane C, Clerico M, Beiki O, Mattoscio M, Piazza F, Fredrikson S, Tramacere I, Scalfari A, Salanti G. Treatment with disease-modifying drugs for people with a first clinical attack suggestive of multiple sclerosis. Cochrane Database Syst Rev 2017; 4:CD012200. [PMID: 28440858 PMCID: PMC6478290 DOI: 10.1002/14651858.cd012200.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The treatment of multiple sclerosis has changed over the last 20 years. The advent of disease-modifying drugs in the mid-1990s heralded a period of rapid progress in the understanding and management of multiple sclerosis. With the support of magnetic resonance imaging early diagnosis is possible, enabling treatment initiation at the time of the first clinical attack. As most of the disease-modifying drugs are associated with adverse events, patients and clinicians need to weigh the benefit and safety of the various early treatment options before taking informed decisions. OBJECTIVES 1. to estimate the benefit and safety of disease-modifying drugs that have been evaluated in all studies (randomised or non-randomised) for the treatment of a first clinical attack suggestive of MS compared either with placebo or no treatment;2. to assess the relative efficacy and safety of disease-modifying drugs according to their benefit and safety;3. to estimate the benefit and safety of disease-modifying drugs that have been evaluated in all studies (randomised or non-randomised) for treatment started after a first attack ('early treatment') compared with treatment started after a second attack or at another later time point ('delayed treatment'). SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group Trials Register, MEDLINE, Embase, CINAHL, LILACS, clinicaltrials.gov, the WHO trials registry, and US Food and Drug Administration (FDA) reports, and searched for unpublished studies (until December 2016). SELECTION CRITERIA We included randomised and observational studies that evaluated one or more drugs as monotherapy in adult participants with a first clinical attack suggestive of MS. We considered evidence on alemtuzumab, azathioprine, cladribine, daclizumab, dimethyl fumarate, fingolimod, glatiramer acetate, immunoglobulins, interferon beta-1b, interferon beta-1a (Rebif®, Avonex®), laquinimod, mitoxantrone, natalizumab, ocrelizumab, pegylated interferon beta-1a, rituximab and teriflunomide. DATA COLLECTION AND ANALYSIS Two teams of three authors each independently selected studies and extracted data. The primary outcomes were disability-worsening, relapses, occurrence of at least one serious adverse event (AE) and withdrawing from the study or discontinuing the drug because of AEs. Time to conversion to clinically definite MS (CDMS) defined by Poser diagnostic criteria, and probability to discontinue the treatment or dropout for any reason were recorded as secondary outcomes. We synthesized study data using random-effects meta-analyses and performed indirect comparisons between drugs. We calculated odds ratios (OR) and hazard ratios (HR) along with relative 95% confidence intervals (CI) for all outcomes. We estimated the absolute effects only for primary outcomes. We evaluated the credibility of the evidence using the GRADE system. MAIN RESULTS We included 10 randomised trials, eight open-label extension studies (OLEs) and four cohort studies published between 2010 and 2016. The overall risk of bias was high and the reporting of AEs was scarce. The quality of the evidence associated with the results ranges from low to very low. Early treatment versus placebo during the first 24 months' follow-upThere was a small, non-significant advantage of early treatment compared with placebo in disability-worsening (6.4% fewer (13.9 fewer to 3 more) participants with disability-worsening with interferon beta-1a (Rebif®) or teriflunomide) and in relapses (10% fewer (20.3 fewer to 2.8 more) participants with relapses with teriflunomide). Early treatment was associated with 1.6% fewer participants with at least one serious AE (3 fewer to 0.2 more). Participants on early treatment were on average 4.6% times (0.3 fewer to 15.4 more) more likely to withdraw from the study due to AEs. This result was mostly driven by studies on interferon beta 1-b, glatiramer acetate and cladribine that were associated with significantly more withdrawals for AEs. Early treatment decreased the hazard of conversion to CDMS (HR 0.53, 95% CI 0.47 to 0.60). Comparing active interventions during the first 24 months' follow-upIndirect comparison of interferon beta-1a (Rebif®) with teriflunomide did not show any difference on reducing disability-worsening (OR 0.84, 95% CI 0.43 to 1.66). We found no differences between the included drugs with respect to the hazard of conversion to CDMS. Interferon beta-1a (Rebif®) and teriflunomide were associated with fewer dropouts because of AEs compared with interferon beta-1b, cladribine and glatiramer acetate (ORs range between 0.03 and 0.29, with substantial uncertainty). Early versus delayed treatmentWe did not find evidence of differences between early and delayed treatments for disability-worsening at a maximum of five years' follow-up (3% fewer participants with early treatment (15 fewer to 11.1 more)). There was important variability across interventions; early treatment with interferon beta-1b considerably reduced the odds of participants with disability-worsening during three and five years' follow-up (OR 0.52, 95% CI 0.32 to 0.84 and OR 0.57, 95% CI 0.36 to 0.89). The early treatment group had 19.6% fewer participants with relapses (26.7 fewer to 12.7 fewer) compared to late treatment at a maximum of five years' follow-up and early treatment decreased the hazard of conversion to CDMS at any follow-up up to 10 years (i.e. over five years' follow-up HR 0.62, 95% CI 0.53 to 0.73). We did not draw any conclusions on long-term serious AEs or discontinuation due to AEs because of inadequacies in the available data both in the included OLEs and cohort studies. AUTHORS' CONCLUSIONS Very low-quality evidence suggests a small and uncertain benefit with early treatment compared with placebo in reducing disability-worsening and relapses. The advantage of early treatment compared with delayed on disability-worsening was heterogeneous depending on the actual drug used and based on very low-quality evidence. Low-quality evidence suggests that the chances of relapse are less with early treatment compared with delayed. Early treatment reduced the hazard of conversion to CDMS compared either with placebo, no treatment or delayed treatment, both in short- and long-term follow-up. Low-quality evidence suggests that early treatment is associated with fewer participants with at least one serious AE compared with placebo. Very low-quality evidence suggests that, compared with placebo, early treatment leads to more withdrawals or treatment discontinuation due to AEs. Difference between drugs on short-term benefit and safety was uncertain because few studies and only indirect comparisons were available. Long-term safety of early treatment is uncertain because of inadequately reported or unavailable data.
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Affiliation(s)
- Graziella Filippini
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Cinzia Del Giovane
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Marinella Clerico
- AOU San Luigi GonzagaUniversity of Turin, Division of NeurologyRegione Gonzole, 13OrbassanoItaly10043
| | | | - Miriam Mattoscio
- Imperial College LondonDepartment of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience LaboratoriesDu Cane RoadLondonUKW12 0NN
| | - Federico Piazza
- AOU San Luigi GonzagaUniversity of Turin, Division of NeurologyRegione Gonzole, 13OrbassanoItaly10043
| | - Sten Fredrikson
- Karolinska InstitutetDepartment of Clinical NeuroscienceStockholmSweden17177
| | - Irene Tramacere
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Antonio Scalfari
- Imperial College LondonDepartment of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience LaboratoriesDu Cane RoadLondonUKW12 0NN
| | - Georgia Salanti
- University of BernInstitute of Social and Preventive Medicine (ISPM)Finkenhubelweg 11BernSwitzerland3005
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11
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Wilson L, Loucks A, Bui C, Gipson G, Zhong L, Schwartzburg A, Crabtree E, Goodin D, Waubant E, McCulloch C. Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices. J Neurol Sci 2014; 344:80-7. [PMID: 25037284 DOI: 10.1016/j.jns.2014.06.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/28/2014] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. METHODS Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. RESULTS Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. CONCLUSION We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
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Affiliation(s)
- Leslie Wilson
- Health Policy and Economics, University of California San Francisco, Departments of Medicine and Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Aimee Loucks
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Christine Bui
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Greg Gipson
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Lixian Zhong
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Amy Schwartzburg
- University of California San Francisco, Department of Neurology, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Elizabeth Crabtree
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Douglas Goodin
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Emmanuelle Waubant
- University of California San Francisco, Regional Pediatric MS Center Director, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Charles McCulloch
- Division of Biostatistics, University of California San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107-1762, USA.
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