Effect of a patient decision aid PDA for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflictReport as inadecuate




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BMC Health Services Research

, 16:10

Healthcare needs and demand

Abstract

BackgroundPatients with type 2 diabetes T2DM often have poor glycemic control on first-line pharmacologic therapy and require treatment intensification. Intensification decisions can be difficult because of many available options and their many benefits and risks. The American Diabetes Association recommends patient-centered, evidence-based tools supporting shared decision-making between patients and clinicians. We developed a patient decision aid PDA targeting decisions about treatment intensification for T2DM. Our objective was to determine the effectiveness of this PDA for patients with T2DM on metformin who require treatment intensification.

MethodsThis study was a pragmatic randomized controlled trial conducted in 27 US primary care and endocrinology clinics. Subjects were English-speaking adults with T2DM receiving metformin with persistent hyperglycemia who were recommended to consider medication intensification. Subjects were randomized to receive either the PDA or usual care UC. Main outcome measures were change in knowledge, decisional self-efficacy, and decisional conflict.

ResultsOf 225 subjects enrolled, 114 were randomized to the PDA and 111 to UC. Mean SD age was 52 1 years, time since T2DM diagnosis was 6 +-−6 years, 45.3 % were male, and most 55.5 % were non-Caucasian. Compared to UC, PDA users had significantly larger knowledge gains 35.0 % 22.3 vs 9.9 % 22.2; P < 0.0001 and larger improvements in self-efficacy 3.7 16.7 vs−3.9 19.2; P < 0.0001 and decisional conflict −22.2 20.6 vs−7.5 16.6; P < 0.0001.

ConclusionsThe PDA resulted in substantial and significant improvements in knowledge, decisional conflict and decisional self-efficacy. Decisional conflict scores after PDA use were within the range that correlates with effective decision-making. This PDA has the potential to facilitate shared-decision-making for patients with T2DM.

Trial registrationNCT02110979

KeywordsType 2 diabetes mellitus Antihyperglycemic medication Shared decision-making Patient decision aid Decisional conflict Decision self-efficacy AbbreviationsDAWN2Diabetes attitudes, wishes and needs DAWN2 STUDY

DCSDecisional conflict scale

DPP-4Dipeptidyl peptidase-4

DSESDecisional self efficacy scale

GLMGeneralized Linear Model

GLP-1Glucagon-like peptide-1 GLP-1S agonists

ITTIntent to treat

MCMCMarkov-Chain-Monte-Carlo

MOMissouri

PDAPatient decision aid

SASStatistics analytics system

SDStandard deviation

SGLT-2Sodium-glucose co-transporter 2 inhibitors

T2DMType 2 diabetes mellitus

TZDThiazolidinediones

UCUsual care

USUnited States

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-016-1262-4 contains supplementary material, which is available to authorized users.

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Author: Robert. A. Bailey - Michael Pfeifer - Alicia C. Shillington - Qing Harshaw - Martha M. Funnell - Jeffrey VanWingen - Nana

Source: https://link.springer.com/







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