Multiple Sclerosis Treatments

The problem: For newly diagnosed MS patients, there are over 10 medication options, each with different benefits, side-effects, modes of administration, and other characteristics.

The approach: A preference study first identified the subgroups of patients with different preference profiles. Prototypes were developed with input from patient focus groups, pilot studies and the clinical team. An MCDA approach was determined to be most useful, where patients express which attributes of treatment matter most using simple sliders, and the treatments are then ordered in line with which option would seem to match the patient’s preference profile. A 1 page pdf is generated that includes the patients preferences for attributes and treatment, patient reported outcomes, and knowledge answer – this is sent to the doctor to inform the discussion about treatment selection.

Status: The decision aid is being tested in a pilot study at the UBC MS Clinic. Contact Nick Bansback ( if you are interested in using this decision aid.

  • Bansback, Nick, et al. “Development and Usability Testing of a Patient Decision Aid for Newly Diagnosed Relapsing Multiple Sclerosis Patients.” BMC Neurology, vol. 19, no. 1, 2019, doi:10.1186/s12883-019-1382-7. - Web Link
Conference presentations:
  • 2017 7th Joint ECTRIMS/ACTRIMS Conference - Web Link
  • 2019 International Shared Decision Making Conference (ISDM)
  • 2019 Society for Medical Decision Making (SMDM)

Total Knee Replacement

The problem: Patients considering Knee Replacement often have unrealistic expectations for the outcomes of knee replacement – overestimating the benefits and underestimating the chance of side-effects, and often do not know about alternative non-surgical options.

The approach: The key difference between this and existing decision aids in TKA is that it is customized for the Alberta context, and data is individualized to patients by searching the existing ABJHI data. In Alberta, patients routinely answer patient reported outcomes pre and post surgery – this decision aid uses the baseline EQ-5D-5L responses, and finds patients who have previously had surgery with similar age, sex, BMI and pre EQ-5D profiles and describes what their outcomes were 3 months post surgery. It then takes patients through 9 key questions asking them to state their preference and importance for each which leads to a graphical summary that informs whether the benefits of surgery outweigh the harms.

Status: The decision aid is being tested in an RCT funded by the EuroQol group. Contact Nick Bansback ( if you are interested in using this decision aid.