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

描述(由申请人提供)：2型糖尿病导致2400多万美国人的生活质量下降和生命周期缩短，给社会和受影响的家庭带来巨大的治疗成本和沉重的负担。除了健康的生活方式外，患者还必须坚持复杂的药物治疗计划，以防止2型糖尿病的并发症，但患者很少参与这些计划的决定，例如增加或更换药物。缺乏患者参与治疗决策可能会导致治疗方案对患者关心的问题、信念、偏好和价值观不敏感或不兼容，这反过来可能导致患者对这些方案的依从性较差。因此，患者缺乏对治疗决策的参与可能会导致糖尿病预后不佳。 决策辅助工具通过提供有关可用选项及其结果的可访问信息，帮助临床医生让患者参与做出深思熟虑的选择。我们小组在学术实践中开发和评估了针对糖尿病治疗的创新决策辅助工具，并发现它们的使用促进了患者参与选择和坚持治疗。 为了确定决策辅助工具将糖尿病证据转化为非学术、非城市初级保健实践的成本效益的能力，需要一项明确的翻译实践试验。在这里，我们建议进行一项试点随机试验，为最终试验的最佳规划和实施提供必要的信息。这项拟议的试点试验旨在获得对患者决策辅助与常规护理在美国中西部非城市实践中患者参与决策、糖尿病护理过程、服药依从性、血糖和心血管风险因素控制以及资源利用等指标上的影响的初步估计。此外，一项平行的定性研究将确定这些做法如何将决策辅助工具的使用纳入其例行公事。 在这项试点试验完成后，我们将对糖尿病决策辅助工具在非学术和非城市实践中的有效性以及促进或抑制患者决策辅助工具在此类实践中成功实施的过程有了新的了解。这些信息将在规划和进行在初级保健中实施糖尿病决策辅助工具的成本效益的最终试验中至关重要。 公共卫生相关性：拟议的试验试图确定患者决策辅助与常规护理对美国中西部非城市实践中患者参与决策、糖尿病护理过程、用药依从性、血糖和心血管风险因素控制以及资源利用的衡量标准的影响。在这项试验完成后，我们将对糖尿病决策辅助工具在非学术和非城市实践中的有效性以及促进或抑制患者决策辅助工具在此类实践中成功实施的过程有了新的了解。

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.