Decisional Attributes of Patients With Diabetes

Montori, Víctor M.; Bryant, Sandra C.; O’Connor, Annette M.; Jorgensen, Neal W.; Walsh, Erin E.; Smith, Steven A.

doi:10.2337/diacare.26.10.2804

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…This does not mean that the healthcare team cannot honestly try to persuade a patient to take courses of action different from those the patient would have chosen on their own, particularly if these seem feasible in the patient's context and are backed by solid scientific evidence of effectiveness. In doing so, clinicians may discover reasons why patients will not be better off with these strategies, and patients may discover and correct misinformation that previously made the alternative unacceptable 27 …”

Section: The Shared Treatment Decision‐making Approach In Chronic Dismentioning

confidence: 99%

A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes

Montori

Gafni

Charles

2006

Health Expectations

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353

345

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In this paper, we discuss the Charles et al. approach to shared treatment decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end-of-life care, surgical treatment of cancer) that generated existing approaches of shared decision-making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient-clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.

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Section: The Shared Treatment Decision‐making Approach In Chronic Dismentioning

confidence: 99%

A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes

Montori

Gafni

Charles

2006

Health Expectations

Self Cite

353

345

View full text Add to dashboard Cite

show abstract

“…Cooper et al (6) found that treatment preferences differ significantly among White, Black and Hispanic patients meeting criteria for major depression. Other studies examining chronic diseases including osteoporosis (7), osteoarthritis (8), diabetes (9) and hypertension (10) have failed to find an association between sociodemographic characteristics and treatment preferences; however, these studies were not designed, nor powered, to examine the impact of race or ethnicity on outcomes.…”

mentioning

confidence: 99%

Racial Disparities in Treatment Preferences for Rheumatoid Arthritis

Constantinescu

Goucher²,

Weinstein³

et al. 2009

Medical Care

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Background Data suggest that differences in patient preferences may account for racial disparities in the use of medical interventions. Racial disparities have also been noted in outcomes and the delivery of healthcare services in chronic disease. Whether treatment preferences in chronic disease differ by race is not known. Methods We elicited treatment preferences for aggressive therapy in patients with rheumatoid arthritis (RA) who identified themselves as being Black or White. Results One hundred fifty consecutive eligible patients were invited to participate. Of these, 136 subjects completed the interview. In unadjusted analysis, 51% of White participants preferred aggressive therapy compared to 16% of Blacks (p<0.0001). Subjects who were married and reported having at least some college education had stronger preferences for aggressive therapy compared to their respective counterparts. After adjusting for covariates, race remained the strongest predictor of aggressive therapy examined in this study [adjusted odds ratio (95% CI) = 11.2 (1.9-64.9)]. Conclusions In this study, fewer Blacks patients preferred aggressive treatment compared to White patients with similar disease severity. These results have important clinical implications because use of aggressive treatment improves both short and long-term outcomes in RA. Efforts to improve patient education and physician communication should be made to ensure that all patients have an accurate understanding of the benefits, as well as risks, associated with the best available treatment options.

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“…New studies involving aspirin should draw the attention of both health care professionals and patients to the value of aspirin use, since it has been repeatedly reported as being underused in the population with diabetes [21][22][23][24][25]. This relative indifference to aspirin therapy also emerges in recent major clinical trials targeting cardiovascular events in patients with diabetes.…”

Section: Discussionmentioning

confidence: 93%

The benefit of aspirin therapy in type 2 diabetes: What is the evidence?

Sirois

Poirier

Moisan

et al. 2008

International Journal of Cardiology

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Many clinical guidelines recommend aspirin therapy for the prevention of cardiovascular events in individuals with type 2 diabetes. However it is unclear whether the level of evidence in guidelines is derived from studies carried out among individuals with diabetes. Medline and Embase databases were searched to retrieve studies published since 1990, evaluating the effect of aspirin on cardiovascular outcomes in subjects with type 2 diabetes. Four studies corresponded to the inclusion criteria. The three clinical trials retrieved could not prove from a statistical point of view, the benefits of aspirin therapy for subjects with type 2 diabetes. Reduction in cardiac mortality was found only in one observational study. Consequently, these findings suggest that the clinical guidelines have based their recommendations upon the expected benefit previously observed in other high-risk populations. Given the lack of hard evidence and the different well-known platelet physiology encountered in patients with diabetes, use of aspirin as a standard treatment at the highest level of evidence in guidelines for subjects with type 2 diabetes should be revisited.

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Decisional Attributes of Patients With Diabetes

Cited by 13 publications

References 21 publications

A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes

A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes

Racial Disparities in Treatment Preferences for Rheumatoid Arthritis

The benefit of aspirin therapy in type 2 diabetes: What is the evidence?

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