Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial
| Autor: | Sumeet Sodhi-Helou, Kevin E. Thorpe, John Maxted, Paul A. Frydrych, David L. Kaplan, Joanna E. M. Sale, Brigida A. Bruno, Deanna Telner, Paul Cantarutti, Dawn Stacey, Karen Chu, Dorothy Choi, Sharon E. Straus, Jeremy Rezmovitz, Fok-Han Leung, Amy Hoang-Kim, Noah Ivers, Catherine H. Yu |
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| Rok vydání: | 2020 |
| Předmět: |
Male
randomized clinical trials Decision quality Decisional conflict law.invention 0302 clinical medicine Randomized controlled trial law Patient-Centered Care Surveys and Questionnaires Decision aids 030212 general & internal medicine Aged 80 and over lcsh:Public aspects of medicine 030503 health policy & services Multilevel model Middle Aged decisional conflict Distress Knowledge lcsh:R858-859.7 Female 0305 other medical science Adult medicine.medical_specialty Adolescent patient assessment of chronic illness care Decision Making shared decision making decision aid Health Informatics lcsh:Computer applications to medicine. Medical informatics Young Adult 03 medical and health sciences Quality of life (healthcare) diabetes distress Intervention (counseling) Diabetes Mellitus medicine Humans Aged Quality of Health Care Internet Original Paper business.industry goals of care lcsh:RA1-1270 quality of life Family medicine Chronic Disease business |
| Zdroj: | Journal of Medical Internet Research Journal of Medical Internet Research, Vol 22, Iss 9, p e16984 (2020) |
| ISSN: | 1438-8871 |
| DOI: | 10.2196/16984 |
| Popis: | Background Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. Objective This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. Methods A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. Results At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; −3.5, 95% CI −7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). Conclusions Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. Trial Registration ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078 |
| Databáze: | OpenAIRE |
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