Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 15, 2019
Date Accepted: Aug 11, 2020
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–a cluster randomized controlled trial
ABSTRACT
Background:
Person-centred care is critical to delivering high quality diabetes care. Shared decision-making is central to person-centred care, and in diabetes care, improved decision quality, patient knowledge and patient risk perception. Delivering person-centred care can be facilitated with the use of patient decision aids. We developed MyDiabetesPlan, an interactive shared decision-making and goal-setting patient decision aid designed to help individualize care priorities and to support an interprofessional approach to SDM.
Objective:
To assess the impact of MyDiabetesPlan (an interactive online shared decision-making and goal-setting aid) on decisional conflict, diabetes distress, health-related quality of life and patient assessment of chronic illness care.
Methods:
A two-step, parallel 10-site clustered randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later). Population: Adults aged 18 and older with diabetes and 2 other comorbidities at 10 family health teams in Southwestern Ontario. Intervention: MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) then patients (second step) were trained on its use. Control participants received Diabetes Canada resources. Data collection: Participants completed validated questionnaires at baseline, 6 and 12 months. Outcomes: Primary outcome was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care and clinician intention to practice interprofessional shared decision-making. Analysis: Multilevel hierarchical regression models were used.
Results:
At study end, the intervention group (n=111) had a greater reduction in total decisional conflict compared to the control group (n=102) (-3.5, 95% confidence interval (CI) -6.6 to -0.5). While there was no difference in diabetes distress nor 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:
Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral supports. Next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. Clinical Trial: Clinicaltrials.gov NCT02379078 Date of Registration: February 11, 2015
Citation
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