An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial.
An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial.
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DOI：
10.1186/1471-2296-14-155
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发表时间：
2013-10-19
影响因子：
2.9
通讯作者：
Lenz M
中科院分区：
文献类型：
--
作者：
Buhse S;Heller T;Kasper J;Mühlhauser I;Müller UA;Lehmann T;Lenz M
缺乏患者参与决策已被认为是治疗成功有限的原因之一。共享决策等概念可能通过支持患者与他们的医生一起做出明智的决定，为高质量的医疗保健做出贡献。已经制定了预防2型糖尿病心脏病发作的多组成部分共享决策方案。它旨在通过提供循证的患者信息，增强患者的知识，支持他们积极参与决策，提高决策质量。在这项研究中，在糖尿病诊所的背景下对该方案的效果进行了评估。一项单盲随机对照试验被用来比较共同决策方案和对照干预。干预措施包括以证据为基础的预防心肌梗死患者决策援助和糖尿病教育人员提供的相应咨询模块。在持续时间和结构上相似，对照干预的目标是营养、运动和压力应对。共有154名年龄在40岁至69岁之间的2型糖尿病患者入选，以前没有缺血性心脏病或中风的诊断，并被分配到干预组或对照-干预组。主要的结果衡量标准是患者对预防心脏病发作的益处和危害的知识，通过标准化的知识测试获得。关键的次要结果衡量标准是个体患者优先考虑的治疗目标的实现情况。治疗目标是指服用他汀类药物、糖化血红蛋白、血压水平和吸烟状况。在咨询后立即评估结果，并在6个月后进行随访。将在意向治疗的基础上进行分析。同时使用定性方法来探索干预的保真度，并深入了解实施过程。促进循证共享决策的干预措施代表了糖尿病护理的一种创新方法。这项研究的结果将提供有关这一概念在德国糖尿病诊所设置中的有效性的信息。ISRCTN84636255
Lack of patient involvement in decision making has been suggested as one reason for limited treatment success. Concepts such as shared decision making may contribute to high quality healthcare by supporting patients to make informed decisions together with their physicians. A multi-component shared decision making programme on the prevention of heart attack in type 2 diabetes has been developed. It aims at improving the quality of decision-making by providing evidence-based patient information, enhancing patients’ knowledge, and supporting them to actively participate in decision-making. In this study the efficacy of the programme is evaluated in the setting of a diabetes clinic. A single blinded randomised-controlled trial is conducted to compare the shared decision making programme with a control-intervention. The intervention consists of an evidence-based patient decision aid on the prevention of myocardial infarction and a corresponding counselling module provided by diabetes educators. Similar in duration and structure, the control-intervention targets nutrition, sports, and stress coping. A total of 154 patients between 40 and 69 years of age with type 2 diabetes and no previous diagnosis of ischaemic heart disease or stroke are enrolled and allocated either to the intervention or the control-intervention. Primary outcome measure is the patients’ knowledge on benefits and harms of heart attack prevention captured by a standardised knowledge test. Key secondary outcome measure is the achievement of treatment goals prioritised by the individual patient. Treatment goals refer to statin taking, HbA1c-, blood pressure levels and smoking status. Outcomes are assessed directly after the counselling and at 6 months follow-up. Analyses will be carried out on intention-to-treat basis. Concurrent qualitative methods are used to explore intervention fidelity and to gain insight into implementation processes. Interventions to facilitate evidence-based shared decision making represent an innovative approach in diabetes care. The results of this study will provide information on the efficacy of such a concept in the setting of a diabetes clinic in Germany. ISRCTN84636255
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
39.2
作者：
Boutron, Isabelle;Moher, David;Ravaud, Philippe
通讯作者：
Ravaud, Philippe
影响因子：
3.5
作者：
Hermanns, Norbert;Kulzer, Bernhard;Haak, Thomas
通讯作者：
Haak, Thomas
影响因子：
3.5
作者：
Lenz, M.;Kasper, J.;Muehlhauser, I.
通讯作者：
Muehlhauser, I.
影响因子：
39.3
作者：
Hense, HW;Schulte, H;Keil, U
通讯作者：
Keil, U