Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
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DOI：
10.1007/s12020-021-02861-4
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发表时间：
2022-03
期刊：
影响因子：
3.7
通讯作者：
Shah ND
中科院分区：
文献类型：
--
作者：
Kunneman M;Branda ME;Ridgeway JL;Tiedje K;May CR;Linzer M;Inselman J;Buffington ALH;Coffey J;Boehm D;Deming J;Dick S;van Houten H;LeBlanc A;Liesinger J;Lima J;Nordeen J;Pencille L;Poplau S;Reed S;Vannelli A;Yost KJ;Ziegenfuss JY;Smith SA;Montori VM;Shah ND
确定共享决策(SDM)工具与指南知情的常规护理在将证据转化为初级保健方面的有效性，并探索该工具的使用如何改变患者对糖尿病药物决策的看法。在这项混合方法多中心整群随机试验中，我们纳入了2型糖尿病患者和他们的初级保健临床医生。我们比较了使用和不使用SDM对话辅助工具时的常规护理。我们评估了参与者报告的决策和SDM的质量(知识、满意度和决策冲突)、临床结果、依从性和基于观察者的患者参与决策(OPTION12量表)。我们使用与患者的半结构化访谈来了解他们的观点。我们招募了来自20个诊所的350名患者和99名临床医生，并采访了26名患者。对话辅助工具的使用增加了患者在遭遇后的知识(正确答案，52%比45%，p = 0.02)和临床医生的参与(平均臂间差异12，7.3(95%CI 3，12)；p = 0.003)。在治疗选择、患者或临床医生满意度、相遇时间、服药依从性或血糖控制方面，手臂间没有差异。定性分析强调了临床医生如何让患者参与决策的差异，干预患者注意到临床医生如何使用对他们重要的因素指导他们进行对话。使用SDM对话辅助工具，在不影响2型糖尿病患者的治疗选择、相遇时间、服药依从性或改善糖尿病控制的情况下，提高患者对SDM的了解和参与程度。未来的干预措施可能需要专门针对治疗适合性不佳的患者。临床试验.gov：NCT01502891。
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. 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. 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. 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. ClinicalTrial.gov: NCT01502891.
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影响因子：
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作者：
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