Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice

Mathers, N. and Ng, C.J. and Campbell, M.J. and Colwell, B. and Brown, I. and Bradley, A. (2012) Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice. BMJ Open, 2 (6). ISSN 2044-6055,

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Abstract

Objective: To determine the effectiveness of a patient decision aid (PDA) to improve decision quality and glycaemic control in people with diabetes making treatment choices using a cluster randomised controlled trial (RCT). Design: A cluster RCT. Setting: 49 general practices in UK randomised into intervention (n=25) and control (n=24). Participants: General practices Inclusion criteria: >4 medical partners; list size >7000; and a diabetes register with >1 of practice population. 191 practices assessed for eligibility, and 49 practices randomised and completed the study. Patients People with type 2 diabetes mellitus (T2DM) taking at least two oral glucose-lowering drugs with maximum tolerated dose with a glycosolated haemoglobin (HbA1c) greater than 7.4 (IFCC HbA1c >57 mmol/mol) or advised in the preceeding 6 months to add or consider changing to insulin therapy. Exclusion criteria: currently using insulin therapy; difficulty reading or understanding English; difficulty in understanding the purpose of the study; visual or cognitive impairment or mentally ill. A total of 182 assessed for eligibility, 175 randomised to 95 intervention and 80 controls, and 167 completion and analysis. Intervention: Brief training of clinicians and use of PDA with patients in single consultation. Primary outcomes: Decision quality (Decisional Conflict Scores, knowledge, realistic expectations and autonomy) and glycaemic control (glycosolated haemoglobin, HbA1c). Secondary outcomes: Knowledge and realistic expectations of the risks and benefits of insulin therapy and diabetic complications. Results: Intervention group: lower total Decisional Conflict Scores (17.4 vs 25.2, p<0.001); better knowledge (51.6 vs 28.8, p<0.001); realistic expectations (risk of 'hypo', 'weight gain', 'complications'; 81.0 vs 5.2, 70.5 vs 5.3, 26.3 vs 5.0 respectively, p<0.001); and were more autonomous in decision-making (64.1 vs 42.9, p=0.012). No significant difference in the glycaemic control between the two groups. Conclusions: Use of the PANDAs decision aid reduces decisional conflict, improves knowledge, promotes realistic expectations and autonomy in people with diabetes making treatment choices in general practice.

Item Type:	Article
Funders:	UNSPECIFIED
Additional Information:	ISI Document Delivery No.: 091WV Times Cited: 1 Cited Reference Count: 38 Mathers, Nigel Ng, Chirk Jenn Campbell, Michael Joseph Colwell, Brigitte Brown, Ian Bradley, Alastair National Institute for Health Research (NIHR) PB-PG-0906-11248; ISRCTN 14842077; Sheffield Health and Social Care NHS Foundation Trust; National Insitute for Health Research; University of Sheffield NM, CJN, MCJ, BC, AB and IB were involved in substantial contribution to conception and design, acquisition of data or analysis and interpretation of data; NM, CJN and MCJ carried out drafting the article or revising it critically for important intellectual content. NM, CJN, MCJ, BC, AB and IB were involved in final approval of the version to be published. NM is the guarantor. This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0906-11248), ISRCTN National Trials Register Number 14842077 and the Sheffield Health and Social Care NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.funded by National Insitute for Health Research, Research for Patient Benefit. NM, CJN, MC, BC, IB and AB have support from the University of Sheffield for the submitted work. Bmj publishing group London
Uncontrolled Keywords:	Primary-care support framework insulin barriers scale validation attitudes risk
Subjects:	R Medicine
Divisions:	Faculty of Medicine
Depositing User:	Ms azrahani halim
Date Deposited:	29 Oct 2014 00:39
Last Modified:	14 Jul 2017 07:19
URI:	http://eprints.um.edu.my/id/eprint/10212

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