Mathers, N.J., Ng, C.J., Campbell, M.J. orcid.org/0000-0003-3529-2739 et al. (3 more authors) (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: British Medical Journal, 2 (6). e001469. ISSN 0959-8138
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%
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 by the BMJ Publishing Group Ltd. All rights reserved.This final article is available for use under the terms of the Creative Commons Attribution Non-Commercial 2.0 Licence; see http://bmjopen.bmj.com |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Nursing and Midwifery (Sheffield) The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number SHEFFIELD HEALTH AND SOCIAL RESEARCH NETWORK PB-PG-0906-11248 SHEFFIELD HEALTH AND SOCIAL RESEARCH CONSORTIUM None |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 11 Apr 2016 12:39 |
Last Modified: | 11 Apr 2016 13:45 |
Published Version: | http://dx.doi.org/10.1136/bmjopen-2012-001469 |
Status: | Published |
Publisher: | British Medical Journal |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2012-001469 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:88276 |