Immunotherapy decision coaching for people with multiple sclerosis - Implementation of an interprofessional decision support programme into clinical practice.

BACKGROUND

Aiming at actively involving patients in the complex immunotherapy decision-making process in multiple sclerosis (MS), we developed DECIMS (Decision Coaching in people with Multiple Sclerosis). This interprofessional decision-support programme consists of nurse-led coaching sessions, an online accessible information tool (DECIMS-Wiki), and a physician's consultation.

OBJECTIVE

To assess the implementation of nurse-led decision coaching in clinical care and to evaluate associated outcomes, including effectiveness, feasibility, and sustainability, alongside a revised DECIMS-Wiki.

METHODS

1-2 coaching sessions led by a nurse (up to 90 min) followed by a physician consultation integrated into the clinical routine care of a university based MS day hospital. Questionnaires were completed by people with MS (PwMS) and health care professionals. The key outcome was acceptance. DECIMS-Wiki was evaluated through an online survey and telephone interviews focusing on the DECIMS-Wiki, which were analysed using qualitative content analysis.

RESULTS

Among 105 participating PwMS, 45% rated the nurse-led coaching as the most helpful component during the decision-making process. Many PwMS (58%) favoured autonomous roles. Patients' decisions matched the physician's perceptions in 77% of consultations. 49% of PwMS chose to start immunotherapy and 30% decided to watch and wait. Data from 53 participants evaluating the DECIMS-Wiki indicated convenient handling, but difficulties in navigation. >80% of participants reported a better understanding of and denied feeling upset by the uncertainties communicated through the material. This was confirmed in interviews (n = 8).

CONCLUSION

DECIMS was successfully implemented in routine outpatient care. Nurse-led decision coaching was feasible, effective, and potentially sustainable, enabling task-sharing between nurses and physicians in shared decision-making. The revised DECIMS-Wiki was well received and facilitated implementation as a complementary tool.