Patient decision aid eases diabetes treatment choices

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.

ORLANDO – A new online tool designed to guide patients who had inadequately controlled type 2 diabetes in making decisions about their self-care got high marks from users during pilot clinical testing.

The patient decision aid (PDA), which was developed with input from patients, clinicians, and an expert panel using a process guided by the International Patient Decision Aid Standards (IPDAS) Collaboration, received an average survey score of 73.31 out of 100 for preparing users for decision making, based on post-test responses from 10 patients. Decision self-efficacy survey scores improved from 84.32 at baseline to 94.32 post test, knowledge (about diabetes and treatment) scores improved from 56.41 to 74.00, and decisional conflict scores improved from 47.32 to 29.11, Alicia C. Shillington, Ph.D., R.N., reported in a poster at the annual meeting of the American Association of Diabetes Educators.

Two-week post-test scores for knowledge and decisional conflict showed sustained benefit, with slight improvement to 74.90 and 26.79, respectively, according to Dr. Shillington of EPI-Q Inc., Oak Brook, Ill.

The final PDA was first tested in two patient focus groups, then in the 10 patients in the pilot study. The patients had type 2 diabetes and were taking metformin. They were evaluated prior to receiving the PDA, immediately after, and again at a 2-week follow-up.

All clinicians who tested the PDA endorsed it, and the vast majority (90%-100% on all measures) said the PDA could help facilitate key aspects of shared decision making (SDM). For example, they said the PDA could help patients understand the risks and benefits of adding a second diabetic medication, identify the importance patients place on those risks and benefits, prepare for the follow-up consultation visit, be involved in decision making as much as they desire, and make more informed decisions.

In addition, the PDA could help clinicians understand the issues that are most important to the patient, tailor counseling to patient preferences for decision participation, positively facilitate the follow-up consultation, positively affect the patient-physician relationship, improve the way time is spent during the follow-up consultation visit, and improve the quality of the follow-up consultation visit.

PDAs are SDM tools that can help patients make treatment choices that are consistent with their values and preferences, Dr. Shillington said, noting that the American Diabetes Association "embraces SDM in selecting antihyperglycemic treatment."

The new PDA, which achieved the highest quality rating from the IPDAS, includes an introduction that covers the reason patients have reached a particular decision point (for example, they are not achieving adequate glycemic control with metformin and lifestyle changes). Next, patients are presented with their options, including various benefits and side effects for different medications.

Patients can then provide feedback via questionnaires that allow them to communicate long-term goals and the relative importance of factors such as the degree of blood sugar reduction, avoiding blood glucose lability, maintaining or losing weight, achieving a convenient dosing schedule, and avoiding injections. Responses on this section are available to clinicians.

Finally, a summary is provided, including a fact sheet that reiterates the risks and benefits of each class of medication in a balanced and unbiased manner; and an option is given for the patient to print the information.

The PDA is currently being evaluated in a randomized controlled validation study involving 220 patients. A Spanish version has also been developed and is in testing to expand access, Dr. Shillington said.

"PDAs for type 2 diabetes mellitus can potentially promote patient-centered care and improve self-management behaviors. Access to high-quality, well-developed SDM tools is needed and may improve the quality of care and better align care with individual patient values," she concluded.

Dr. Shillington reported having no disclosures.