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: Cluster Randomized Controlled Trial.

Catherine Yu,Fok-Han Leung,Sharon E Straus,Amy Hoang-Kim,Kevin E Thorpe,David Kaplan,Paul Frydrych,Noah Ivers,Dawn Stacey,Joanna Sale,John Maxted,Dorothy Choi,Sumeet Sodhi-Helou,Deanna Telner,Karen Chu,Paul Cantarutti,Jeremy Rezmovitz,Brigida A Bruno

doi:10.2196/16984

Abstract

BackgroundPerson-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM.ObjectiveThis study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level.MethodsA two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used.ResultsAt the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; −3.5, 95% CI −7.4 to 0.42). Although there was no difference in diabetes distress or 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).ConclusionsUse of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery.Trial RegistrationClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078

Highlights

Person-centered care, whereby health care providers are encouraged to partner with patients to co‐design and deliver personalized care [1], is critical to delivering high-quality diabetes care [2]
This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level
There was no difference in diabetes distress or 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)

Summary

Introduction

Person-centered care, whereby health care providers are encouraged to partner with patients to co‐design and deliver personalized care [1], is critical to delivering high-quality diabetes care [2]. Shared decision making (SDM) is central to person-centered care [3] and can be facilitated with the use of patient decision aids (PtDAs), such as Diabetes Medication Choice [4] or patient activation programs [5]. A meta-analysis of 16 studies using SDM in diabetes care found an association with improved decision quality, patient knowledge, and patient risk perception [6]. Engagement of the person in the decision-making process to make a high-quality decision is an important step in delivering person-centered care. Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM.

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