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Impact of shared decision making on improving patient-clinician interactions and ms quality measures: a pilot study
Author(s): ,
E. Rudell
Affiliations:
@Point of Care, Livingston, NJ
,
A. Ambeskovic
Affiliations:
@Point of Care, Livingston, NJ
,
M.F. Ingram
Affiliations:
@Point of Care, Livingston, NJ
,
B.J. Oliver
Affiliations:
Dartmouth-Hitchcock, Lebanon, NH
,
G. Elwyn
Affiliations:
Dartmouth-Hitchcock, Lebanon, NH
,
J.D. Bowen
Affiliations:
Swedish Neuroscience Institute, Seattle, WA
,
B. Severson
Affiliations:
Swedish Neuroscience Institute, Seattle, WA
,
P. Repovic
Affiliations:
Swedish Neuroscience Institute, Seattle, WA
,
P. Qian
Affiliations:
Swedish Neuroscience Institute, Seattle, WA
,
D. Machemer
Affiliations:
Genentech, Inc., San Francisco, CA, United States
,
S. Shankar
Affiliations:
Genentech, Inc., San Francisco, CA, United States
R. Sih-Meynier
Affiliations:
Genentech, Inc., San Francisco, CA, United States
ECTRIMS Online Library. Bowen J. Oct 12, 2018; 229125; P1285
James D. Bowen
James D. Bowen
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Abstract: P1285

Type: Poster Sessions

Abstract Category: Therapy - Others

Introduction: Advances in multiple sclerosis (MS) offer many treatment options with varying efficacy, safety, and modes of administration. Optimal treatment decisions are preference sensitive and must integrate patient knowledge, values, and preferences. Shared decision making (SDM) involves communication in which patients and clinicians work together to make optimal healthcare decisions that align with what matters most to patients, according to the National Quality Forum. Patient-centered SDM facilitates adherence and patient satisfaction. @Point of Care, Swedish Neuroscience Institute, the Dartmouth Institute, and Genentech collaborated to evaluate the effect of SDM training for both patients and their clinicians on improved SDM and clinical outcomes.
Objectives: Determine if patient/clinician SDM education and training improved MS patient-clinician interactions and improved outcomes.
Methods: MS patients (100) entered a randomized, parallel, 2-arm, controlled, pilot SDM trial at the Swedish Neuroscience Institute MS Center and were randomized (1:1) to either the SDM training intervention group (I) or the control group (C), with no SDM training. Each group was stratified by MS phenotype (RRMS~60%, SPMS~35%, PPMS~5%). Two clinicians were assigned to the I group and two to the C group. SDM training for the I group was provided following baseline measures, and at ~4 months and ~8 months after baseline. The primary outcome is increased SDM, measured for patients and clinicians by the SDM Questionnaire and for patients by the Patient Activation MeasureTM (PAM). Secondary patient outcomes are improved clinical parameters, including cognitive function (SDMT), depression (PHQ-9), fatigue (MFIS), and quality of life (MSQOL-54).
Results: Preliminary analysis of matched patient-clinician pairs (25 I, 23 C) at baseline, 4 month, and 8 month assessments revealed that PAM scores trended higher for the I group (p=0.07 NS). The sample size was too small to assess by MS phenotype. Patient SDM scores for the I group are trending flat from baseline to follow-up (p=0.27 NS) whereas the C group demonstrated a significant decline from baseline to follow-up (p=0.05).
Conclusions: The trend toward improved SDM in the Intervention group suggests SDM education and training may effectively improve patient-clinician collaboration and enhance the patient experience in MS. More insights will be provided in the final analysis, including impact of SDM on MS-specific clinical outcomes.
Disclosure: Elaine Rudell, CHCP: Nothing to disclose
Asli Ambeskovic: Nothing to disclose
Michele Fallon Ingram: Nothing to disclose
Brant J. Oliver, PhD, MS, MPH, APRN-BC: Received Principal Investigator research support from Biogen.
Glynn Elwyn, MD, PhD, MSc: Director of &think LLC, which owns the registered trademark for "Option Grids" patient decision aids; provides consultancy in the domain of shared decision making and patient decision aids to Access Community Health Network, Chicago, and EBSCO Health.
James D. Bowen, MD: Received consulting fees from Biogen IDEC, EMD Serono, Genentech, Inc., a Member of the Roche Group, and Novartis Pharmaceuticals Corporation; is on the speakers´ bureau of Acorda Therapeutics, Biogen IDEC, EMD Serono, Genentech, Inc., a Member of the Roche Group, Novartis Pharmaceuticals Corporation, and Teva Neuroscience; has received contracted research support from Alexion, Alkermes, Biogen IDEC, Celgene, Genentech, Inc., a Member of the Roche Group, Genzyme, Novartis Pharmaceuticals Corporation, and TG Therapeutics; and has ownership interest in Amgen.
Barbara Severson, ARNP: Nothing to disclose.
Pavle Repovic, MD, PhD: Received honoraria from Acorda, Biogen, EMD Serono, Genentech, Inc., a Member of the Roche Group, Sanofi, and Teva Neuroscience; and has received consulting fees from Biogen, EMD Serono, Genentech, Inc., a Member of the Roche Group, Sanofi, and Teva Neuroscience.
Peiqing Qian, MD: Received honoraria from Biogen, Genzyme, and Teva Neuroscience; has received consulting fees from Genzyme; and has received contracted research from Biogen, Teva Neuroscience, and TG Therapeutics.
Daniel Machemer, PhD: Employed by and has ownership interest (stocks) in Genentech, a Member of the Roche Group.
Shashi Shankar, MPH: Employed by and has ownership interest (stocks) in Genentech, a Member of the Roche Group.
Regina Sih-Meynier, PharmD: Employed by and has ownership interest (stocks) in Genentech, a Member of the Roche Group.

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