1. Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention
- Author
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Jeanette Y. Ziegenfuss, Mark Linzer, Kathleen J. Yost, Angela L.H. Buffington, Marleen Kunneman, Megan E. Branda, Steven A. Smith, Janet Lima, Victor M. Montori, Steven Reed, Annie LeBlanc, James R. Deming, Kristina Tiedje, Juliette T. Liesinger, Anna Vannelli, Jennifer L. Ridgeway, Sara Poplau, Carl May, Nilay Shah, Jordan D Coffey, Sara Dick, Deborah H. Boehm, Laurie J. Pencille, Joanne Nordeen, Holly K. Van Houten, and Jonathan Inselman
- Subjects
medicine.medical_specialty ,Patient–clinician communication ,Patient-centered care ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,Decision Making ,Psychological intervention ,Decisional conflict ,Decision Support Techniques ,Medication Adherence ,Endocrinology ,Intervention (counseling) ,Decision aids ,medicine ,Humans ,Conversation ,Cluster randomised controlled trial ,Shared decision making ,Glycemic ,media_common ,business.industry ,Diabetes ,Type 2 Diabetes Mellitus ,Patient-clinician communication ,Diabetes Mellitus, Type 2 ,Family medicine ,Original Article ,Patient Participation ,business - Abstract
Purpose To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. Clinical trial registration ClinicalTrial.gov: NCT01502891.
- Published
- 2021