Comparison of Therapeutic Goals and Preferences in Multiple Sclerosis Patients and Providers Using Nominal Group Technique (P3.100)

OBJECTIVE: To compare the therapeutic goals and preferences of multiple sclerosis (MS) patients and MS providers. BACKGROUND: Incorporating patient preferences into therapeutic decisions promotes shared decision-making and informed values-based choices. METHODS: We conducted 14 structured focus groups using Nominal Group Technique in Colorado, Massachusetts, and Georgia. Participants responded to one of three questions: goals for managing MS, decisions about disease modifying therapy (DMT), and decisions about changes in managing MS. Responses were shared, consolidated, and ranked. Weights were assigned and scores summed to develop a prioritized list for each meeting. RESULTS: 48 ethnically diverse MS patients (79[percnt] female, 54[percnt] white) and 40 providers with subspecialty training in MS participated, generating an average of 33 responses per meeting. The most important goals for patients were achieving independence and avoiding fatigue, vision loss, disabling relapses, and bladder/bowel issues. Most of these specific goals were not included in providers lists, who more broadly prioritized preventing disability and inflammation. For DMT decisions, both patients and providers prioritized effectiveness in slowing the disease process, but patients also prioritized impact on quality-of-life and avoiding long-term risks and side-effects, while providers prioritized a confirmed MS diagnosis and disease aggressiveness. For decisions about changing treatment, both patients and providers prioritized slowing the progression of disability. Uniquely, patients prioritized mental function, avoiding new symptoms, ability to manage symptoms, and new or better treatments, while providers prioritized decrease in new MRI activity and relapse rate. CONCLUSIONS: There were differences in therapeutic goals and preferences between patients and providers as well as differences in how similar preferences were articulated. Patients tended to focus on specific symptoms and side-effects, whereas providers focused more broadly on disability and disease activity, using summary terms. This suggests a need for tools to bridge communication gaps in discussions about MS treatment. Study supported by Biogen Disclosure: Dr. Col has received personal compensation for activities with Biogen Idec, Emmi Solutions, Epi-Q, and Janssen Scientific. Dr. Solomon has received personal compensation from Haymarket Media as a speaker. Dr. Qu has nothing to disclose. Dr. Springmann has received personal compensation for activities with Shared Decision Making Resources as a consultant. Dr. Ionete received personal compensation for activities with Genzyme-Sanofi, TEVA, and Biogen as a member of the scientific advisory board. Dr. Pbert has nothing to disclose. Dr. Anthony has nothing to disclose. Dr. Griffin has nothing to disclose. Dr. Tierman has received research support from Shared Decision Making Resources. Dr. Kutz has nothing to disclose. Dr. Berrios Morales has nothing to disclose. Ms. Hopson has received personal compensation for activities with Shared Decision Making Resources as consultant. Dr. Phillips holds stock and/or stock options in Biogen Idec. Dr. Alvarez has received personal compensation for activities with Teva Neuroscience, Biogen, Genzyme, Genentech, and Novartis.