Shared decision making for patients with type 2 diabetes: a randomized trial in primary care.
BACKGROUND
Patient-centered diabetes care requires shared decision making (SDM). Decision aids promote SDM, but their efficacy in nonacademic and rural primary care clinics is unclear.


METHODS
We cluster-randomized 10 practices in a concealed fashion to implement either a decision aid (DA) about starting statins or one about choosing antihyperglycemic agents. Each practice served as a control group for another practice implementing the other type of DA. From April 2011 to July 2012, 103 (DA=53) patients with type 2 diabetes participated in the trial. We used patient and clinician surveys administered after the clinical encounter to collect decisional outcomes (patient knowledge and comfort with decision making, patient and clinician satisfaction). Medical records provided data on metabolic control. Pharmacy fill profiles provided data for estimating adherence to therapy.


RESULTS
Compared to usual care, patients receiving the DA were more likely to report discussing medications (77% vs. 45%, p<.001), were more likely to answer knowledge questions correctly (risk reduction with statins 61% vs. 33%, p=.07; knowledge about options 57% vs. 33%, p=.002) and were more engaged by their clinicians in decision making (50. vs. 28, difference 21.4 (95% CI 6.4, 36.3), p=.01). We found no significant impact on patient satisfaction, medication starts, adherence or clinical outcomes, in part due to limited statistical power.


CONCLUSIONS
DAs improved decisional outcomes without significant effect on clinical outcomes. DAs designed for point-of-care use with type 2 diabetes patients promoted shared decision making in nonacademic and rural primary care practices.


BACKGROUND
NCT01029288.
Knowledge and Evaluation Research Unit, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
Megan E
ME
Branda
Annie
A
LeBlanc
Nilay D
ND
Shah
Kristina
K
Tiedje
Kari
K
Ruud
Holly
H
Van Houten
Laurie
L
Pencille
Marge
M
Kurland
Barbara
B
Yawn
Victor M
VM
Montori
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010358:Patient Participation; D011320:Primary Health Care