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

• 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
• 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' 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

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型糖尿病会导致质量丧失和寿命减少，超过2400万美国人，成本巨大，对社会和受影响家庭的治疗负担很大。除了健康的生活方式外，患者还必须遵守复杂的药物治疗计划，以防止2型糖尿病的并发症，但患者很少参与有关这些计划的决定，例如增加或更换药物。缺乏患者参与治疗决策可能会导致对患者的关注，信念，偏好和价值观既不敏感的方案，又可能导致患者对这些方案的依从性差。因此，缺乏患者参与治疗决策可能导致糖尿病不良的结果。 决策辅助工具是帮助临床医生通过提供有关可用选项及其结果的可访问信息来帮助患者做出故意选择的工具。我们的小组已经制定并评估了针对学术实践中糖尿病治疗的创新决策艾滋病，发现他们的使用促进了患者参与选择和遵守治疗的参与。 为了确定决策辅助工具能够成本效益将糖尿病证据转化为非学术非城市非城市初级保健实践的能力，需要进行确定的转化实用试验。在这里，我们建议进行一项飞行员随机试验，以提供最佳计划和执行确定试验所需的信息。拟议的试点试验旨在获得对患者决策的影响的初步估计，即对患者参与决策，糖尿病护理过程，药物依从性，血管血管疾病和心血管危险因素控制以及中西部非旅行中的资源利用的措施。此外，一项平行的定性研究将确定实践如何将决策辅助工具的使用纳入其常规。 该试点试验完成后，我们将对非学术非城市实践的糖尿病决策有效性以及促进或抑制成功实施此类实践的患者决策AIDS的过程有新的知识。对于计划和进行实施糖尿病决策AIDS在初级保健中的成本效益的确定性试验，此信息将至关重要。 公共卫生相关性：拟议的试验旨在确定患者决策AIDS与常规护理对患者参与决策，糖尿病护理过程，药物依从性，血糖和心血管危险因素控制以及中西部非城市实践中资源利用的影响。该试验完成后，我们将对非学术非城市实践的糖尿病决策有效性以及促进或抑制成功实施此类实践的患者决策有助于的过程有新的知识。