Purpose: Multiple sclerosis (MS) is a chronic autoimmune disease, affecting 4 in 100,000 persons. Patients with MS have a 50% lifetime prevalence of depression. The prevalence of suicide in MS is 4-7 times higher than the national average. Decision aids (DAs) have been shown to help patients make treatment choices tailored to their personal preferences. The goal of this study was to evaluate a DA on a cohort of MS patients making an initial treatment decision for depression.
Method: Patients at a MS clinic received the video DA “Coping with Symptoms of Depression” Health Dialog© 2005. Participants were asked to: 1) complete a pre-DA questionnaire, 2) watch the DA, and 3) complete a post-DA questionnaire. The DA was incorporated into the clinical process using a microsystems approach. Clinicians reviewed patient responses to identify gaps in knowledge and to guide follow up discussion about which treatments would be clinically appropriate. Measures: Patient demographics, treatment intention before and after viewing DA, preferred role in decision making, knowledge questions (multiple choice), value scores (0 not important – 10 extremely important) and DA acceptability
Result: Between 9 November 2010 and 30 April 2011, 26 patients borrowed a DA; 16 (62%) enrolled in the study by completing a questionnaire. Average age was 44.5. 81% were female. After watching the DA, fewer patients were unsure about their treatment decision (44% vs. 13%), gaps in patient knowledge were identified from knowledge question responses, and patients had a clear preference for sharing the treatment decision with their clinician (88%). “Getting relief from depression symptoms” (mean=9.3/10) and “Returning to usual activities” (mean 9.0/10) were the most important patient values. The majority of participants (71%) felt it was important for health care providers to offer the DA to patients.
Conclusion: Distributing a patient DA for treating depression appears to be beneficial for this group of patients. After viewing the video and meeting with their provider, patients were well informed, clear about their personal values and prepared to make a decision. Patients found the DA acceptable and would recommend it to others facing the same decision. Clinicians found the information from the questionnaire to be of benefit in guiding their follow-up consultation. This study presents initial research on the use of decision support in multiple sclerosis psychiatric care.
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making