Identification and Prioritization of Important Attributes of Disease-Modifying Drugs in Decision Making among Patients with Multiple Sclerosis: A Nominal Group Technique and Best-Worst Scaling

Abstract

ObjectivesUnderstanding the preferences of patients with multiple sclerosis (MS) for disease-modifying drugs and involving these patients in clinical decision making can improve the concordance between medical decisions and patient values and may, subsequently, improve adherence to disease-modifying drugs. This study aims first to identify which characteristics–or attributes–of disease-modifying drugs influence patients´ decisions about these treatments and second to quantify the attributes’ relative importance among patients.MethodsFirst, three focus groups of relapsing-remitting MS patients were formed to compile a preliminary list of attributes using a nominal group technique. Based on this qualitative research, a survey with several choice tasks (best-worst scaling) was developed to prioritize attributes, asking a larger patient group to choose the most and least important attributes. The attributes’ mean relative importance scores (RIS) were calculated.ResultsNineteen patients reported 34 attributes during the focus groups and 185 patients evaluated the importance of the attributes in the survey. The effect on disease progression received the highest RIS (RIS = 9.64, 95% confidence interval: [9.48–9.81]), followed by quality of life (RIS = 9.21 [9.00–9.42]), relapse rate (RIS = 7.76 [7.39–8.13]), severity of side effects (RIS = 7.63 [7.33–7.94]) and relapse severity (RIS = 7.39 [7.06–7.73]). Subgroup analyses showed heterogeneity in preference of patients. For example, side effect-related attributes were statistically more important for patients who had no experience in using disease-modifying drugs compared to experienced patients (p < .001).ConclusionsThis study shows that, on average, patients valued effectiveness and unwanted effects as most important. Clinicians should be aware of the average preferences but also that attributes of disease-modifying drugs are valued differently by different patients. Person-centred clinical decision making would be needed and requires eliciting individual preferences.

Comparison of preferences of healthcare professionals and MS patients for attributes of disease‐modifying drugs: A best‐worst scaling

“…Therefore, the Checklist for Reporting Results of Internet E‐Surveys was followed for reporting the design and the results . We used the same best‐worst scaling that was performed to elicit preferences for patients with MS . The best‐worst scaling included 27 attributes, which were identified in a two‐stage procedure.…”

“…An example of a choice task for neurologists and MS nurses is presented in Figure . Further description on the identification, selection and definition of attributes and on the development of the choice tasks and the questionnaire is described in detail elsewhere …”

“…An assessment of the average preferences could be valuable for selecting the information that needs to be included in the decision aid to ensure effectively supporting the shared decision‐making process without making the use of the decision aid too cognitively burdensome for the patient. Preferences of patients for attributes of DMDs have been evaluated in several stated preference studies . Recently, focus groups and a best‐worst scaling were conducted to identify and prioritize a range of attributes that could be important in clinical decision making from the patients’ perspective .…”

“…Preferences of patients for attributes of DMDs have been evaluated in several stated preference studies . Recently, focus groups and a best‐worst scaling were conducted to identify and prioritize a range of attributes that could be important in clinical decision making from the patients’ perspective . This study found that the average MS patient regarded the effects on disability progression and quality of life as the most important attributes of DMDs in the decision, followed by the effect on the relapse rate, severity of side effects and the effect on the severity of relapses .…”

“…Recently, focus groups and a best‐worst scaling were conducted to identify and prioritize a range of attributes that could be important in clinical decision making from the patients’ perspective . This study found that the average MS patient regarded the effects on disability progression and quality of life as the most important attributes of DMDs in the decision, followed by the effect on the relapse rate, severity of side effects and the effect on the severity of relapses . Several studies showed that preferences of healthcare professionals for treatment options can differ from the preferences of patients .…”