Journal Article

The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial

LeBlanc, Annie, May, Carl R, Yawn, Barbara P, Shah, Nilay D, Matthews, Marc, Ruud, Kari L, Branda, Megan E, Boehmer, Kasey R, Montori, Victor M, Tiedje, Kristina, Pencille, Laurie J, Van Houten, Holly

2012

Overview

Background Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. Methods/Design We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid ( Statin Choice and Aspirin Choice, or Diabetes Medication Choice ) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Discussion Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. Trial registration NCT00388050

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Aspirin / Aspirin - therapeutic use / Cardiovascular diseases / Cardiovascular Diseases - drug therapy / Cardiovascular Diseases - etiology / Cardiovascular Diseases - prevention & control / Cardiovascular prevention / Choice Behavior / Chronic illnesses / Clinics / Cluster Analysis / Comparative Effectiveness Research / Consent / Decision making / Decision Support Techniques / Diabetes / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - psychology / Diabetes therapy / Family medicine / Health Administration / Health care policy / Health Informatics / Health sciences / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Hypoglycemic agents / Implementation / Male / Medical practices / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Metabolism / Methods / Minnesota / Nursing Research / Patient compliance / Patient education / Patient Education as Topic / Patient Participation / Patient-Centered Care - methods / Practice research / Primary care / Professional-Patient Relations / Public Health / Qualitative Research / Referral and Consultation / Risk Factors / Rural Health Services - manpower / Rural Health Services - standards / Shared decision making / Statins / Study Protocol / Suburban areas / Type 2 diabetes / Urban Health Services - manpower / Urban Health Services - standards