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The Impact of Decision Aids to Enhance Shared Decision Making for Diabetes

决策辅助对增强糖尿病共同决策的影响

基本信息

批准号：
7699932
负责人：
VICTOR MANUEL MONTORI
金额：
$ 22.62万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-15 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7699932
关键词：
Address Adherence Affect Agreement American Awareness Belief Caring Centers for Disease Control and Prevention (U.S.)Communities Complex Decision Aid Decision Making Development Diabetes Mellitus Disease Education Effectiveness Enrollment Failure Family Fright Glycosylated hemoglobin A Goals Health Professional Intervention Knowledge LDL Cholesterol Lipoproteins Lead Life Life Style Measures Medicine Metabolic Metabolic Control Non-Insulin-Dependent Diabetes Mellitus Outcome Patients Pharmaceutical Preparations Pharmacologic Substance Pharmacotherapy Physicians&apos Offices Practical trial Practice Guidelines Preventive Primary Care Physician Primary Health Care Process Qualitative Research Quality of Care Randomized Randomized Controlled Clinical Trials Research Resources Risk Self Care Societies Testing Time Translating Translations Treatment Protocols Visit base cardiovascular risk factor compliance behavior cost cost effectiveness diabetes control disability effective therapy effectiveness trial health care delivery health disparity health literacy improved innovation medication compliance novel pilot trial preference prevent programs public health relevance shared decision making theories tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Type 2 diabetes causes loss of quality and diminished duration of life for over 24 million Americans with great costs and heavy burden of treatment both for society and for affected families. In addition to healthy lifestyles, patients must adhere to complex drug therapy programs to prevent the complications of type 2 diabetes, but patients rarely involve themselves in decisions about these programs, e.g., adding or changing medicines. Lack of patient involvement in making treatment decisions may lead to regimens that are neither sensitive to nor compatible with patient concerns, beliefs, preferences, and values, which in turn may contribute to poor patient adherence to these regimens. Thus, lack of patient involvement in treatment decision-making may contribute to poor diabetes outcomes. Decision aids are tools that help clinicians involve patients in making deliberate choices by providing accessible information about the options available and their outcomes. Our group has developed and evaluated innovative decision aids addressing diabetes treatments in academic practices and found that their use promoted patient involvement in choice and adherence to treatment. To determine the ability of decision aids to cost-effectively translate diabetes evidence into nonacademic nonurban primary care practices, a definitive translational practical trial is needed. Here, we propose to conduct a pilot randomized trial to provide information necessary for the optimal planning and conduct of the definitive trial. The proposed pilot trial seeks to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision-making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization in nonurban practices in Midwestern US. In addition, a parallel qualitative study will determine how the practices incorporated use of the decision aids into their routines. Upon completion of this pilot trial, we will have new knowledge about both the effectiveness of diabetes decision aids in nonacademic nonurban practices and about the processes that promote or inhibit the successful implementation of patient decision aids in such practices. This information will be essential in the planning and conduct of a definitive trial of the cost-effectiveness of implementing diabetes decision aids in primary care. PUBLIC HEALTH RELEVANCE: The proposed trial seeks to determine the impact of patient decision aids vs. usual care on measures of patient involvement in decision-making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization in nonurban practices in Midwestern US. Upon completion of this trial, we will have new knowledge about both the effectiveness of diabetes decision aids in nonacademic nonurban practices and about the processes that promote or inhibit the successful implementation of patient decision aids in such practices.

描述（由申请人提供）：2型糖尿病导致超过2400万美国人的生活质量下降和寿命缩短，给社会和患者家庭带来了巨大的成本和沉重的治疗负担。除了健康的生活方式外，患者还必须坚持复杂的药物治疗方案，以预防2型糖尿病的并发症，但患者很少参与这些方案的决策，例如，增加或更换药物。缺乏患者对治疗决策的参与可能导致方案既不敏感也不符合患者的关注、信仰、偏好和价值观，这反过来可能导致患者对这些方案的依从性较差。因此，缺乏患者参与治疗决策可能导致糖尿病预后不良。