Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial

Abstract

BackgroundNot providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma.MethodsA parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score –37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models.ResultsFifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9–23.2] to 25.1 [23.1–27.0] in the education + DA group (P = 0.0002) and from 24.0 [22.3–25.7] to 26.0 [24.0–28.0] in the education group (P = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups.ConclusionsEducation improved knowledge, decisional conflict, and asthma control whether the DA was added or not.

Patient evaluations of asthma counselling quality in primary health care — a cross-sectional survey

“…Patients in this study were satisfied with the patient-centred counselling, as has been shown in earlier research (Rajala et al 2018). More specifically, previous studies have proposed that patient-centred counselling supports patient decisionmaking (Gagne et al 2017) and promotes the selfmanagement of asthma (Rajala et al 2018). In this study, patients who had been subjected to an asthma test were more likely to be satisfied with counselling.…”

“…Additionally, subjecting a patient to an asthma test was found to significantly influence satisfaction with counselling among the respondents of this study and, as such, should be studied further both in Finland and international contexts. This type of research is important from patient and societal perspectives, as high-quality counselling has been shown to reduce hospital admissions (Gagne et al 2017) and improve lung function (Gibson et al 2009) among asthma patients.…”

“…Patient-centred counselling is an approach that focuses on individual patient needs (Goeman et al 2013;Raitanen et al 2015;Murray & O'Neill 2018) and is implemented in a way that considers the patient's cultural background (Purnell 2014). This type of counselling allows patients to discuss their treatment and how to manage asthma disease with healthcare staff (Raitanen et al 2015;Gagne et al 2017). It is important to note that patients are generally more satisfied with the counselling if it is performed in a confidential manner (Clark et al 2010;Kääriäinen & Kyngäs 2010;Lee et al 2016).…”

“…High-quality counselling has many benefits for asthma patients. It helps clients make correct decisions (Gagne et al 2017) and have a positive attitude towards both the disease and adherence to care (Kääriäinen 2007;Clark et al 2010;Pallasaho & Pietinalho 2018;Oikarinen et al 2017). Furthermore, high-quality counselling can positively influence the patient's quality of life and asthma control (Gibson et al 2009;Agbetile & Green 2011;Schuermans et al 2018).…”

Decision aids that facilitate elements of shared decision making in chronic illnesses: a systematic review

“…Additional file 3 presents the risk of bias assessment on the outcome level per study. Besides the study of Gagné et al [ 29 ], all studies have an unclear or high risk of bias for all outcomes assessed in this review.

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