Impact of Decision Aids to Enhance Shared Decision Making for Diabetes

Study Overview
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Brief Summary
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The proposed trial seeks to determine the impact of patient decision aids versus usual care on measures of patient involvement in decision-making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization in nonurban practices in the Midwestern United States. Upon completion of this trial, the investigators will have new knowledge about both the effectiveness of diabetes decision aids in nonacademic nonurban practices and about the processes that promote or inhibit the successful implementation of patient decision aids in such practices.

Detailed Description
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Type 2 diabetes causes loss of quality and diminished duration of life for over 24 million Americans with great costs and heavy burden of treatment for both society and for affected families. Decision aids are tools that help clinicians involve patients in making deliberate choices by providing accessible information about the options available and their outcomes. We propose to conduct a cluster randomized trial to obtain an estimate of the impact of patient decision aids versus usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. Participating clinicians will be trained to use decision aid tools to discuss starting either new diabetes medications or new statins with their enrolled patients. Surveys completed by clinicians and patients will assess satisfaction with decision making and knowledge gained by patients. 3- and 6-month follow-up surveys completed by patients will assess adherence to chosen medications and sustained knowledge. Primary analysis will be conducted utilizing generalized linear models. Some visits will be video and/or audio recorded with permission, and a small subset of patients, clinicians, and support staff will be interviewed by an experienced qualitative researcher using a semi-structured interview guide. Primary care practices were enrolled then matched by size (less than or equal to 2 clinicians or greater than 2 clinicians) and randomly allocated by a statistician to 1) the use of the Diabetes Medication Choice decision aid and usual care for lipid therapy medication (statin) discussion during the encounter with subjects or to 2) the use of the Statin Choice decision aid and usual care for antihyperglycemic mediations discussion during the encounter with subjects.

Official Title
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Impact of Decision Aids to Enhance Shared Decision Making for Diabetes

Conditions
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Diabetes

Intervention / Treatment
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* Other: Diabetes Medication Choice Decision Aid
* Other: Statin Choice Decision Aid
* Other: Usual care for lipid therapy medication
* Other: Usual care for antihyperglycemic medication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary care provider is participating in trial Are an adult (≥ 18 years) with type 2 diabetes English speaking Recognize their primary care provider as their main diabetes care provider Declare being available for follow-up for six months after treatment decision Exclusion Criteria: - Have major barriers to provide written informed consent and to participate in shared decision making (i.e., severe vision or hearing impairment, cognitive impairment, non-English speaking) Additional Inclusion Criteria for Diabetes Medication: Have a clinical diagnosis of type 2 diabetes for one year or more (c-peptide test is not required) Use 0, 1, or 2 oral hypoglycemic agents at maximum doses Have stable but inadequate glycemic control or worsening glycemic control as identified by their most recent HbA1c measure (within 12 months of the time of eligibility over 7.3% Be identified by provider as a medically-appropriate candidate for diabetes medications, (i.e., have not contraindications to taking the medications, e.g., allergy). Additional Exclusion Criteria for Diabetes Medication: - Use insulin therapy. Additional Inclusion Criteria for Cardiovascular Medication: Have a clinical diagnosis of type 2 diabetes for any duration (c-peptide test is not required). Be identified by provider as a medically-appropriate candidate for statins, (i.e., have not contraindications to taking the medications, e.g., allergy). Additional Exclusion Criteria for Cardiovascular Medication: - Use a statin currently.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Statin Choice Decision Aid<br>Subjects will receive an intervention of Statin Choice Decision Aid and usual care for antihyperglycemic medication discussion with their clinician. | Other: Statin Choice Decision Aid<br>* Statin Choice Cards<br>Other: Usual care for antihyperglycemic medication<br>* Clinicians will follow their clinic's usual care practice for antihyperglycemic medication discussions.<br>|
| Active Comparator: Diabetes Medication Choice Decision Aid<br>Subjects will receive an intervention of Diabetes Medication Choice Decision Aid and usual care for lipid therapy medication discussion with their clinician. | Other: Diabetes Medication Choice Decision Aid<br>* Diabetes Medication Choice cards<br>Other: Usual care for lipid therapy medication<br>* Clinicians will follow their clinic's usual care practice for lipid therapy medication (statin) discussions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decisional quality (knowledge, decisional conflict, and satisfaction) |  | Immediately (within 10 minutes) following clinical encounter, and 3- & 6-months post encounter | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Provider satisfaction |  | Immediately following clinical encounter | 
| Patient medication adherence |  | 6-months following clinical encounter | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Decision aid, Cardiovascular risk, Patient education