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dc.contributor.authorCol, Nananda F
dc.contributor.authorSolomon, Andrew J
dc.contributor.authorAlvarez, Enrique
dc.contributor.authorPbert, Lori
dc.contributor.authorIonete, Carolina
dc.contributor.authorBerriosMorales, Idanis
dc.contributor.authorChester, Jennifer
dc.contributor.authorKutz, Christen
dc.contributor.authorIwuchukwu, Crystal
dc.contributor.authorLivingston, Terrie
dc.contributor.authorSpringmann, Vicky
dc.contributor.authorCol, Hannah V
dc.contributor.authorNgo, Long H
dc.identifier.citationCol NF, Solomon AJ, Alvarez E, Pbert L, Ionete C, BerriosMorales I, Chester J, Kutz C, Iwuchukwu C, Livingston T, Springmann V, Col HV, Ngo LH. Implementing Shared Decision-Making for Multiple Sclerosis: The MS-SUPPORT Tool. Mult Scler Relat Disord. 2023 Dec;80:105092. doi: 10.1016/j.msard.2023.105092. Epub 2023 Oct 21. PMID: 37931489.en_US
dc.description.abstractBackground: Disease modifying therapies (DMTs) offer opportunities to improve the course of multiple sclerosis (MS), but decisions about treatment are difficult. People with multiple sclerosis (pwMS) want more involvement in decisions about DMTs, but new approaches are needed to support shared decision-making (SDM) because of the number of treatment options and the range of outcomes affected by treatment. We designed a patient-centered tool, MS-SUPPORT, to facilitate SDM for pwMS. We sought to evaluate the feasibility and impact of MS-SUPPORT on decisions about disease modifying treatments (DMTs), SDM processes, and quality-of-life. Methods: This multisite randomized controlled trial compared the SDM intervention (MS-SUPPORT) to control (usual care) over a 12-month period. English-speaking adults with relapsing MS were eligible if they had an upcoming MS appointment and an email address. To evaluate clinician perspectives, participants' MS clinicians were invited to participate. Patients were referred between November 11, 2019 and October 23, 2020 by their MS clinician or a patient advocacy organization (the Multiple Sclerosis Association of America). MS-SUPPORT is an online, interactive, evidence-based decision aid that was co-created with pwMS. It clarifies patient treatment goals and values and provides tailored information about MS, DMTs, and adherence. Viewed by patients before their clinic appointment, MS-SUPPORT generates a personalized summary of the patient's treatment goals and preferences, adherence, DMT use, and clinical situation to share with their MS clinician. Outcomes (DMT utilization, adherence, quality-of-life, and SDM) were assessed at enrollment, post-MS-SUPPORT, post-appointment, and quarterly for 1 year. Results: Participants included 501 adults with MS from across the USA (84.6% female, 83% white) and 34 of their MS clinicians (47% neurologists, 41% Nurse Practitioners, 12% Physician Assistants). Among the 203 patients who completed MS-SUPPORT, most (88.2%) reported they would recommend it to others and that it helped them talk to their doctor (85.2%), understand their options (82.3%) and the importance of taking DMTs as prescribed (82.3%). Among non-users of DMTs at baseline, the probability ratio of current DMT use consistently trended higher over one-year follow-up in the MS-SUPPORT group (1.30 [0.86-1.96]), as did the cumulative probability of starting a DMT within 6-months, with shorter time-to-start (46 vs 90 days, p=0.24). Among the 222 responses from 34 participating clinicians, more clinicians in the MS-SUPPORT group (vs control) trended towards recommending their patient start a DMT (9 of 108 (8%) vs 5 of 109 (5%), respectively, p=0.26). Adherence (no missed doses) to daily-dosed DMTs was higher in the MS-SUPPORT group (81.25% vs 56.41%, p=.026). Fewer patients forgot their doses (p=.046). The MS-SUPPORT group (vs control) reported 1.7 fewer days/month of poor mental health (p=0.02). Conclusions: MS-SUPPORT was strongly endorsed by patients and is feasible to use in clinical settings. MS-SUPPORT increased the short-term probability of taking and adhering to a DMT, and improved long-term mental health. Study limitations include selection bias, response bias, social desirability bias, and recall bias. Exploring approaches to reinforcement and monitoring its implementation in real-world settings should provide further insights into the value and utility of this new SDM tool.en_US
dc.relation.ispartofMultiple Sclerosis and Related Disordersen_US
dc.rights© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( nc-nd/4.0/).en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.subjectDecision Support Systems, Clinicalen_US
dc.subjectDecision making, shareden_US
dc.subjectMedication Adherenceen_US
dc.subjectMultiple Sclerosisen_US
dc.subjectMultiple Sclerosis, Relapsing-Remitting / drug therapyen_US
dc.subjectPatient preferencesen_US
dc.subjectPsychological Well-Beingen_US
dc.subjectRandomized Controlled Trialen_US
dc.titleImplementing Shared Decision-Making for Multiple Sclerosis: The MS-SUPPORT Toolen_US
dc.typeJournal Articleen_US
dc.source.journaltitleMultiple sclerosis and related disorders
dc.identifier.journalMultiple sclerosis and related disorders
dc.contributor.departmentPopulation and Quantitative Health Sciencesen_US
dc.contributor.departmentPrevention Research Centeren_US

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© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (
Except where otherwise noted, this item's license is described as © 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( nc-nd/4.0/).