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At a glance: The ONWARDS insulin icodec trials

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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2015 | Research article

Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict

Authors: Robert. A. Bailey, Michael Pfeifer, Alicia C. Shillington, Qing Harshaw, Martha M. Funnell, Jeffrey VanWingen, Nanada Col

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Patients 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.

Methods

This 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.

Results

Of 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).

Conclusions

The 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 registration

Appendix
Available only for authorised users
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Metadata
Title
Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict
Authors
Robert. A. Bailey
Michael Pfeifer
Alicia C. Shillington
Qing Harshaw
Martha M. Funnell
Jeffrey VanWingen
Nanada Col
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1262-4

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