Effect of a Patient Decision Aid (PDA) for Type 2 Diabetes on Knowledge, Decisional Self-efficacy, and Decisional Conflict

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2016 Jan 15

PMID 26762150

Citations 31

Authors

Robert A Bailey

Michael Pfeifer

Alicia C Shillington

Qing Harshaw

Martha M Funnell

Jeffrey VanWingen

Nanada Col

Affiliations

Soon will be listed here.

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: NCT02110979.

Citing Articles

Perspectives of People with Type 2 Diabetes Mellitus Towards a Decision Aid Assessing Preferences of Glucose-Lowering Drugs: The Dilemma of Choosing.

Roldan Munoz S, Mol P, de Vries F, van Dijk P, Hillege H, Postmus D Patient Prefer Adherence. 2025; 19:215-234.

PMID: 39882148 PMC: 11776401. DOI: 10.2147/PPA.S486553.

The effects of shared decision-making informed dietary intervention based on digital health technology in older adults with type 2 diabetes mellitus: A randomized controlled trial.

Zhang W, Zhu X, Que X, Zhang X Digit Health. 2024; 10:20552076241272514.

PMID: 39403713 PMC: 11472356. DOI: 10.1177/20552076241272514.

Shared Decision-Making in Cardiovascular Risk Factor Management: A Systematic Review and Meta-Analysis.

Elias S, Chen Y, Liu X, Slone S, Turkson-Ocran R, Ogungbe B JAMA Netw Open. 2024; 7(3):e243779.

PMID: 38530311 PMC: 10966415. DOI: 10.1001/jamanetworkopen.2024.3779.

Decision aids for people facing health treatment or screening decisions.

Stacey D, Lewis K, Smith M, Carley M, Volk R, Douglas E Cochrane Database Syst Rev. 2024; 1:CD001431.

PMID: 38284415 PMC: 10823577. DOI: 10.1002/14651858.CD001431.pub6.

Shared decision making in sarcopenia treatment.

An K, Wu Z, Qiu Y, Pan M, Zhang L, An Z Front Public Health. 2023; 11:1296112.

PMID: 38074732 PMC: 10710138. DOI: 10.3389/fpubh.2023.1296112.

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