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
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 i...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2012
|
| Subjects: | |
| Online Access: | http://eprints.um.edu.my/10212/1/Mathers-2012-Clinical_effectivene.pdf |
| _version_ | 1796946041004621824 |
|---|---|
| author | Mathers, N. Ng, C.J. Campbell, M.J. Colwell, B. Brown, I. Bradley, A. |
| author_facet | Mathers, N. Ng, C.J. Campbell, M.J. Colwell, B. Brown, I. Bradley, A. |
| author_sort | Mathers, N. |
| collection | UM |
| description | 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. |
| first_indexed | 2024-03-06T05:25:39Z |
| format | Article |
| id | um.eprints-10212 |
| institution | Universiti Malaya |
| language | English |
| last_indexed | 2024-03-06T05:25:39Z |
| publishDate | 2012 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | um.eprints-102122017-07-14T07:19:05Z http://eprints.um.edu.my/10212/ 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. Ng, C.J. Campbell, M.J. Colwell, B. Brown, I. Bradley, A. R Medicine 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. BMJ Publishing Group 2012 Article PeerReviewed application/pdf en http://eprints.um.edu.my/10212/1/Mathers-2012-Clinical_effectivene.pdf 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, http://www.ncbi.nlm.nih.gov/pubmed/23129571 |
| spellingShingle | R Medicine Mathers, N. Ng, C.J. Campbell, M.J. Colwell, B. Brown, I. Bradley, A. 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | R Medicine |
| url | http://eprints.um.edu.my/10212/1/Mathers-2012-Clinical_effectivene.pdf |
| work_keys_str_mv | AT mathersn clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice AT ngcj clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice AT campbellmj clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice AT colwellb clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice AT browni clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice AT bradleya clinicaleffectivenessofapatientdecisionaidtoimprovedecisionqualityandglycaemiccontrolinpeoplewithdiabetesmakingtreatmentchoicesaclusterrandomisedcontrolledtrialpandasingeneralpractice |