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

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.