Report Ingrid Kremer's PhD-research trip to the University of British Columbia


This research was partially supported by the Student Research Award of the Association of Canada Studies in the Netherlands.

"I had the opportunity to visit the University of British Columbia (UBC) in Vancouver, Canada, to conduct a study as part of my PhD thesis at Maastricht University in the Netherlands. My PhD thesis focusses on supporting patients with multiple sclerosis (MS) and their healthcare professionals in making a shared decision about the medication for MS. The increasing number of medication options available for MS with each conflicting characteristics regarding efficacy and burden of the medication complicates decision-making. A trade-off between characteristics needs to be made, and the patient’s preferences for the medication characteristics should be considered. Moreover, patients have difficulties with adhering and persisting to medication. Patient education about medication options and inclusion of the patient’s preferences in the decision could enable patients to take the medication as prescribed by their neurologist on the long term.

In my PhD-project, I developed a patient decision aid that helps Dutch patients to understand their disease and their medication options. Moreover, it supports patients and the neurologist to discuss the patient’s preferences and include these preferences in the decision.

Researchers of the University of British Columbia (UBC) developed a similar patient decision aid for Canadian patients. Thanks to my visit to UBC, we got the opportunity to exchange experiences and ideas about the development of the patient decision aid, to lay a foundation for international collaboration regarding patient decision aids for multiple sclerosis, and to collaborate on evaluating the potential cost-effectiveness of shared decision-making supported with a patient decision aid.

Information about the cost-effectiveness provides policy makers in healthcare institutions insights into whether effects on the patient’s health outcomes and quality of life of shared decision-making supported with a patient decision aid would outweigh the extra costs. The results of the evaluation showed, on the one hand, that if the patient decision aid would decrease the patient’s uncertainty about the medication choice and would ensure long-term appropriate use of the drug, patients would have improved health outcomes and quality of life. On the other hand, implementation of shared decision-making supported with a patient decision aid raises total costs, caused mainly by the higher medication intake. The extent to which the costs increase is, therefore, highly dependent on the increase in medication use and the costs of the medication. Policy makers could use these results to decide whether implementation of shared decision-making supported with a patient decision aid would be worthwhile. Moreover, the results guide the direction of further evaluation studies of shared decision making supported with patient decision aids in terms of outcome measurement and cost-effectiveness.

Besides the valuable opportunity to work with the experts researchers of UBC on the project, I was also able to attend a number of interesting area-specific meetings organized by UBC and Simon Fraser University. Additionally, my visit gave me a chance to experience the Canadian way of life, to get to know other graduate students, experience the beautiful sceneries surrounding Vancouver, and of course be part of typical traditions such as Halloween. I am thankful to the Association of Canada Studies in The Netherlands for giving me financial support for my visit to UBC. The knowledge, skills and experiences I gained are priceless."

This research was undertaken by Ingrid Kremer, MSc. in September and October 2018 as part of her PhD project at Maastricht University.