Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial

Denig, Petra; Schuling, Jan; Haaijer‐Ruskamp, Flora; Voorham, Jaco

doi:10.1136/bmj.g5651

Cited by 59 publications

(82 citation statements)

References 42 publications

(23 reference statements)

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“…We expected some variation amongst patients, as the incomplete utilization of decision aids by patients has been previously reported and may relate to the salience of materials to the individual patient. 43,44 Another uncertainty is the effect of the design of the decision/choice set in the PtDAs. The choice architecture of the LONG and SHORT DA directed the patient to consider 5 choices: take no treatment, continue current treatment, begin Enbrel now, ask doctor about other options, and defer choice for now.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis

et al. 2017

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Objective. To compare the effects a pharmaceutical industry decision guide and International Patient Decision Aids Standard (IPDAS) compliant patient decision aids (PtDA) on patient medication beliefs and choice to intensify therapy. Methods. Rheumatoid arthritis (RA) patients, who had never taken etanercept (Enbrel), took part in a mail survey. They were presented with a hypothetical decision scenario where they were asked to consider adding etanercept to their current regimen. Each patient was randomized to review 1 of 3 forms of an etanercept-specific decision support: a long PtDA (LONG DA), a short PtDA (SHORT DA), or the manufacturer’s Enbrel decision guide (Pharm Booklet). Results. We had 402 RA patients participate in the study (response rate, 52%). Of the patients randomized to the Pharm Booklet, 30.6% elected to initiate etanercept. Only 14.6% and 14.0% of patients who reviewed the LONG DA or SHORT DA choose to take etanercept (χ2 = 15.7; P < 0.001). Patients who reviewed the LONG DA or SHORT DA had a greater increase in knowledge about etanercept than those who reviewed the Pharm Booklet. There was no difference in decisional conflict among the groups. A logistic regression model explained 44.2% (R2 = 0.442) of patient choice to intensify therapy by initiating etanercept. The strongest predictor of choice to intensify therapy were beliefs about etanercept’s ability to improve symptoms (OR = 2.56, 96%CI [1.71, 3.80]), and its use by others like the respondent (OR = 2.24, 95%CI [1.49, 3.35]). Mediation analysis confirmed the presence of a partial mediating effect of decision support on patients’ intent to take etanercept (OR = 0.59, 95%CI [0.39, 0.89]). Conclusions. Patients supported by the Pharm Booklet were twice as likely to choose to intensify therapy. The Pharm Booklet’s effects are partially mediated through persuasive communication techniques that influence patients’ beliefs that symptoms will improve, and increase social normative beliefs, rather than by increasing the relevant knowledge, clarifying patient values about positive or negative treatment outcomes, or increasing their self-efficacy.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis

et al. 2017

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“…83 A randomized controlled trial evaluated whether assessment of barriers to self care and strategies to cope with these barriers, implemented telephonically by a diabetes educator, was superior to usual care with control for attention time. 76 The intervention group received a model of care in which a geriatric diabetes team assessed barriers and developed strategies to help patients to cope with barriers.…”

Section: Care Managementmentioning

confidence: 99%

Management of diabetes mellitus in older people with comorbidities

Huang

2016

BMJ

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Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

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Section: The Effects Of Empowerment Therapy In Type 2 Diabetes Andmentioning

confidence: 99%

“…For example, in a group of 344 patients with type 2 diabetes, intervention was introduced to assist the patients in their decision-making ability, as well as to provide individually tailored training and more treatment options [34]. After the intervention, there was no statistically significant increase in the empowerment score (determined using a structured questionnaire) and no change in the lipid profile compared to the control group [34]. In another study (the Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes, or PLEASED study), no improvement in metabolic control in patients with type 2 diabetes was observed after one year of the intervention compared to the diabetes self-management education (DSME) control group [35].…”

Section: The Effects Of Empowerment Therapy In Type 2 Diabetes Andmentioning

confidence: 99%

Empowerment in the Treatment of Diabetes and Obesity

Łuczyński

Głowińska-Olszewska

Bossowski

2016

Journal of Diabetes Research

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As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.

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Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial

Cited by 59 publications

References 42 publications

Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis

Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis

Management of diabetes mellitus in older people with comorbidities

Empowerment in the Treatment of Diabetes and Obesity

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