The development of a web-based patient decision aid for type 2 diabetes to support patients and their healthcare professionals in the treatment decision-making process.

Abstract

Introduction: Patient decision aids (PDAs) are useful tools in facilitating shared decision-making (SDM) between patients and healthcare professionals. The International Patient Decision Aids Standards (IPDAS) Collaboration developed a model for the systematic development of PDAs. However, there is still some uncertainty about which approach is most suitable for each step of the development process and questions remain on how to best involve patients and healthcare professionals in the development process. We aim to provide insights into how the IPDAS model for the development of a PDA for type 2 diabetes could be used.
 Target audience: Our developed PDA is for individuals with type 2 diabetes, who need to decide on a new or additional glucose-lowering treatment (lifestyle and/or medical treatment), and their healthcare professionals in primary care.
 Methods: The PDA was systematically developed in the Netherlands, following five steps: 1) define scope; 2) establishment of expert group; 3) design of PDA (determine, among others, the preferences of patients and healthcare professionals); 4) draft prototype; and 5) iterative process of review and redraft. The preferences of patients and healthcare professionals, in combination with input from the expert group and the available evidence of the treatment options for type 2 diabetes, were used to determine the content of the PDA and develop a prototype. Content was written by a scientific writer. The prototype of the PDA was reviewed by the research team and expert group.
 Patient and public involvement: A multidisciplinary expert group was established at the beginning of the study. The expert group consisted of patients with type 2 diabetes (N=2), a representative from the Dutch Diabetes Association, a representative from the Netherlands Diabetes Federation and healthcare professionals representing the broad range of disciplines involved in type 2 diabetes care (i.e., general practitioner, diabetes nurse, practice nurse, pharmacist, endocrinologist and dietician). The expert group met twice a year (online) and advised on the development process and content of the PDA. The expert group meetings were interactive and small-group discussions were held using statements about different aspects of the PDA, such as the format of the PDA.
 Results: Individuals with type 2 diabetes wanted to compare multiple treatment options for both their clinical aspects and their impact on daily life. Following the systematic development process, a web-based PDA was developed consisting of five sections: 1) information about type 2 diabetes and the different treatment options; 2) comparison of treatment options based on, for example, clinical outcomes, effect on weight and risk of cardiovascular diseases; 3) questions to test patients’ knowledge; 4) value-clarification exercise; and 5) summary of the patient's answers and notes. 
 Conclusions: We provided insights into how you could use the IPDAS systematic development process for the development of a PDA. Involving patients and healthcare professionals throughout the development process is valuable for the development of the PDA for type 2 diabetes. They were involved in an early and iterative way, which ensured that the PDA is compatible with the needs and preferences of all relevant stakeholders in Dutch diabetes care.