A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial.
OBJECTIVE
Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician.


METHODS
We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit. Providers and patients were blinded to the study hypothesis. Immediately after the clinical encounter, patients completed a survey including questions on trust (range 0 to total trust = 100), knowledge, and decisional conflict. Researchers reviewed videotaped encounters and assessed patient participation (using the OPTION scale) and visit length.


RESULTS
Overall mean trust score was 91 (median 97.2, IQR 86, 100). After adjustment for patient characteristics, results suggested greater total trust (trust = 100) with the decision aid [odds ratio (OR) 1.77, 95% CI 0.94, 3.35]. Total trust was associated with knowledge (for each additional knowledge point, OR 1.3, 95% CI 1.1, 1.6), patient participation (for each additional point in the OPTION scale, OR 1.1, 95% CI 1.1, 1.2), and decisional conflict (for every 5-point decrease in conflict, OR 1.5, 95% CI 1.2, 1.9). Total trust was not associated with visit length, which the decision aid did not significantly affect. There was no significant effect interaction across the trial factors.


CONCLUSIONS
Preliminary evidence suggests that decision aids do not have a large negative impact on trust in the physician and may increase trust through improvements in the decision-making process.
Nannenga
Michael R
MR
Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Montori
Victor M
VM
Weymiller
Audrey J
AJ
Smith
Steven A
SA
Christianson
Teresa J H
TJ
Bryant
Sandra C
SC
Gafni
Amiram
A
Charles
Cathy
C
Mullan
Rebecca J
RJ
Jones
Lesley A
LA
Bolona
Enrique R
ER
Guyatt
Gordon H
GH
D000368:Aged; D002755:Choice Behavior; D020000:Decision Support Systems, Clinical; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011369:Professional-Patient Relations; D035502:Trust; D014743:Videotape Recording
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors