A COMPARISON OF PATIENTS' AND HEALTHCARE PROFESSIONALS' PREFERENCES FOR THE CHARACTERISTICS OF DISEASE MODIFYING DRUGS IN DECISION MAKING ABOUT MULTIPLE SCLEROSIS TREATMENT

Purpose: The choice between disease modifying drugs (DMDs) for the treatment of multiple sclerosis (MS) becomes more often a shared decision between the patient and the healthcare professionals. This study assessed which characteristics of DMDs are most important for healthcare professionals in selecting a DMD for a patient. Subsequently, their perspective was compared to the patients’ perspective to get insight into whether improvement in communication between patients and healthcare professionals would be needed. 

Method(s): A best-worst scaling (BWS) was conducted among 28 neurologists and 33 MS-specialized nurses experienced with the DMD decision. Twenty-seven DMD characteristics were evaluated in 17 choice tasks of 5 characteristics each, by asking respondents to choose the most and least important characteristic in the decision. Hierarchical Bayes analysis was used to obtain mean relative importance scores (RIS) per DMD characteristic between 0 and 100. Therefore, a RIS of 3.7 per characteristics would indicate that all characteristics are equally important in the decision. The results were compared with results of an earlier conducted BWS among 185 MS patients using t-tests or non-parametric tests on the characteristics’ RIS. 

Result(s): According to the healthcare professionals, the effect of the DMD on disease progression and quality of life were most important (mean RIS: 9.5 and 9.2), in line with the patients’ preferences. For many other attributes, significant differences in RIS were found between patients and professionals, but absolute differences were small. Noteworthy, absolute difference for safety (risks of serious side effects that can be life-threatening or result in severe disabilities) was relatively large (RIS difference: 2.7), which resulted in safety being considered by healthcare professionals as third most important in the DMD decision compared to eighth most important for patients. 

Conclusion(s): Healthcare professionals and MS patients overall agree about which DMD characteristics most influence the decision, but safety is, on average, more important for healthcare professionals compared to patients. Whether patients are more willing to take risk or whether healthcare professionals understand the risks better, safety should receive extensive attention in the shared decision-making process.