scholarly journals Choice of Intensive Lifestyle Change and/or Metformin after Shared Decision Making for Diabetes Prevention: Results from the Prediabetes Informed Decisions and Education (PRIDE) Study

2021 ◽  
pp. 0272989X2110012
Author(s):  
Tannaz Moin ◽  
Jacqueline M. Martin ◽  
Carol M. Mangione ◽  
Jonathan Grotts ◽  
Norman Turk ◽  
...  
Keyword(s):  
Decision Making ◽  
Usual Care ◽  
Shared Decision Making ◽  
Diabetes Prevention ◽  
Lifestyle Change ◽  
Diabetes Incidence ◽  
Shared Decision ◽  
Informed Decisions ◽  
Unit Increase ◽  
Pride Study

Introduction While the Diabetes Prevention Program Study demonstrated that intensive lifestyle change and metformin both reduce type 2 diabetes incidence, there are little data on patient preferences in real-world, clinical settings. Methods The Prediabetes Informed Decisions and Education (PRIDE) study was a cluster-randomized trial of shared decision making (SDM) for diabetes prevention. In PRIDE, pharmacists engaged patients with prediabetes in SDM using a decision aid with information about both evidence-based options. We recorded which diabetes prevention option(s) participants chose after the SDM visit. We also evaluated logistic regression models examining predictors of choosing intensive lifestyle change ± metformin, compared to metformin or usual care, and predictors of choosing metformin ± intensive lifestyle change, compared to intensive lifestyle change or usual care. Results Among PRIDE participants ( n = 515), 55% chose intensive lifestyle change, 8.5% chose metformin, 15% chose both options, and 21.6% declined both options. Women (odds ratio [OR] = 1.60, P = 0.023) had higher odds than men of choosing intensive lifestyle change. Patients >60 years old (OR = 0.50, P = 0.028) had lower odds than patients <50 years old of choosing metformin. Participants with higher body mass index (BMI) had higher odds of choosing intensive lifestyle change (OR = 1.07 per BMI unit increase, P = 0.005) v. other options and choosing metformin (OR = 1.06 per BMI unit increase, P = 0.008) v. other options. Conclusions Patients with prediabetes are making choices for diabetes prevention that generally align with recommendations and expected benefits from the published literature. Our results are important for policy makers and clinicians, as well as program planners developing systemwide approaches for diabetes prevention.

Shared Decision-Making for Diabetes Prevention—One-Year Results from the Prediabetes Informed Decision and Education (PRIDE) Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 168-OR ◽  
Author(s):  
TANNAZ MOIN ◽  
NORMAN TURK ◽  
CAROL MANGIONE ◽  
YELBA CASTELLON-LOPEZ ◽  
KIA SKRINE JEFFERS ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Diabetes Prevention ◽  
Informed Decision ◽  
Shared Decision ◽  
One Year ◽  
Pride Study

scholarly journals 3256 Effectiveness of Shared Decision-Making for Diabetes Prevention: 12-month Results from the Prediabetes Informed Decision and Education (PRIDE) Randomized Trial

2019 ◽  
Vol 3 (s1) ◽  
pp. 39-40
Author(s):  
Tannaz Moin ◽  
O. Kenrik Duru ◽  
Norman Turk ◽  
Janet S. Chon ◽  
Dominick L. Frosch ◽  
...  
Keyword(s):  
Decision Making ◽  
Weight Loss ◽  
Usual Care ◽  
Shared Decision Making ◽  
Diabetes Prevention ◽  
Controlled Trial ◽  
Diabetes Prevention Program ◽  
Shared Decision ◽  
Increased Risk ◽  
Cluster Randomized

OBJECTIVES/SPECIFIC AIMS: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences.The objective was to test the effectiveness of a prediabetes SDM intervention. METHODS/STUDY POPULATION: This was a cluster-randomized controlled trial in 20 primary care clinics within a large regional health system. Participants were overweight/obese adults with prediabetes (BMI>24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics.Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention; DPP, DPP +/− metformin, metformin only, or usual care. RESULTS/ANTICIPATED RESULTS: Uptake of DPP and/or metformin was higher among SDM participants (n=351) than controls receiving usual care (n = 1,028; 38% vs. 2%, p<.001). At 12-months follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (−5.3 vs. −0.2, p < .001). DISCUSSION/SIGNIFICANCE OF IMPACT: A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4-months and weight loss at 12-months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk.

scholarly journals Right For Me: a pragmatic multi-arm cluster randomised controlled trial of two interventions for increasing shared decision-making about contraceptive methods

2021 ◽  
Author(s):  
Rachel Thompson ◽  
Gabrielle Stevens ◽  
Ruth Manski ◽  
Kyla Z Donnelly ◽  
Daniela Agusti ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Literacy ◽  
Usual Care ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Contraceptive Methods ◽  
Care Visit ◽  
Health Care Visit

Objectives: There is a paucity of evidence on how to facilitate shared decision-making under real-world conditions and, in particular, whether interventions should target patients, health care providers, or both groups. Our objectives were to assess the comparative effectiveness, feasibility, and acceptability of patient- and provider-targeted interventions for improving shared decision-making about contraceptive methods in a pragmatic trial that prioritised applicability to real-world care. Design: The study design was a 2X2 factorial cluster randomized controlled trial with four arms: (1) video + prompt card ("video"), (2) decision aids + training ("decision aids"), (3) dual interventions ("dual"), and (4) usual care. Clusters were 16 primary and/or reproductive health care clinics that deliver contraceptive care in the Northeast United States. Participants: Participants were people who had completed a health care visit at a participating clinic, were assigned female sex at birth, were aged 15-49 years, were able to read and write English or Spanish, and had not previously participated in the study. Participants were enrolled for 13 weeks before interventions were implemented in clinics (pre-implementation cohort) and for 26 weeks after interventions were implemented in clinics (post-implementation cohort). 5,018 participants provided data on at least one study outcome. Interventions: Interventions were a video and prompt card that encourage patients to ask three specific questions in the health care visit and a suite of decision aids on contraceptive methods and training for providers in how to use them to facilitate shared decision-making with patients in the health care visit. Main outcome measures: The primary outcome was shared decision-making about contraceptive methods. Secondary outcomes spanned psychological, behavioural, and health outcomes. All outcomes were patient-reported via surveys administered immediately, four weeks, and six months after the health care visit. Results: We did not observe any between-arm difference in the differences in shared decision-making between the pre- and post-implementation cohorts for the sample as a whole (video vs. usual care: adjusted odds ratio (AOR)=1.23 (95% confidence interval (CI): 0.82 to 1.85), p=0.80; decision aids vs. usual care: AOR=1.47 (95% CI: 0.98 to 2.18), p=0.32; dual vs. video: AOR=0.95 (95% CI: 0.64 to 1.41), p=1.00; dual vs. decision aids: AOR=0.80 (95% CI: 0.54 to 1.17), p=0.72) or for participants with adequate health literacy. Among participants with limited health literacy, the difference in shared decision-making between the pre- and post-implementation cohorts was different in the video arm from the usual care arm (AOR=2.40 (95% CI: 1.01 to 5.71), p=.047) and was also different in the decision aids arm from the usual care arm (AOR=2.65 (95% CI: 1.16 to 6.07), p=.021), however these differences were not robust to adjustment for multiple comparisons. There were no intervention effects on the secondary outcomes among all participants nor among prespecified subgroups. With respect to intervention feasibility, rates of participant-reported exposure to the relevant intervention components were 9.4% for the video arm, 31.5% for the decision aids arm, and 5.0% for the dual arm. All interventions were acceptable to most patients. Conclusions: The interventions studied are unlikely to have a meaningful population-wide impact on shared decision-making or other outcomes in real-world contraceptive care without additional strategies to promote and support implementation. Selective use of the interventions among patients with limited health literacy may be more promising and, if effective, could reduce disparities in shared decision-making. Trial registration: ClinicalTrials.gov NCT02759939.

scholarly journals Ethnic and Racial Differences in Adoption of Evidence-based Diabetes Prevention Strategies and Weight Loss Outcomes in a Shared Decision-Making Intervention

2021 ◽  
Author(s):  
Yelba Castellon-Lopez ◽  
O. Kenrik Duru ◽  
Norman Turk ◽  
Gerardo Moreno ◽  
Keith Norris ◽  
...  
Keyword(s):  
Decision Making ◽  
Weight Loss ◽  
Shared Decision Making ◽  
Weight Change ◽  
Diabetes Prevention ◽  
Evidence Based ◽  
Shared Decision ◽  
Prevention Strategies ◽  
Weight Loss Outcomes ◽  
Racial Ethnic

Abstract Background: To promote health equity, interventions should achieve similar clinical outcomes among all subgroups. However, evidence from real-world Diabetes Prevention Program (DPP) translation studies suggests that adoption of diabetes prevention strategies and weight loss outcomes may vary by race and ethnicity.Methods: In this retrospective analysis, we examined adoption of diabetes prevention strategies and weight change outcomes among participants who received a shared decision making (SDM) intervention as part of the Prediabetes Informed Decisions and Education (PRIDE) study. We compared (1) uptake of DPP and/or metformin and (2) percent weight change at 12 months stratified by race/ethnicity using generalized linear mixed effects models. Results: SDM participants (n=515) were on average 56 years old (SD=11.0) with HbA1c 6.0% (SD=.20) and BMI of 30.3 (SD=5.2) who self-identified as non-Hispanic White (NHW) (39.2%), non-Hispanic Asian/Pacific Islander (NHAPI) (18.4%), Hispanic (16.7%), or non-Hispanic Black (NHB) (14.4%). There were no significant differences in adoption of DPP and/or metformin between racial/ethnic groups. NHB and Hispanic participants lost significantly less weight at 12 months as compared to NHW participants (-1.0% and -1.2%, respectively, vs. -3.3%, both comparisons p<.01). Conclusion: While adoption of evidence-based options for diabetes prevention did not vary, Hispanics and NHB lost significantly less weight than NHW at 12-months follow-up after SDM. Minority groups have a higher risk of type 2 diabetes and racial/ethnic disparities in weight change outcomes after adoption of diabetes prevention strategies can further compound risk. These findings have important implications for ongoing efforts to augment diabetes prevention and health equity nationally.

Integrating Palliative Care in Ambulatory Care of Noncancer Serious Chronic Illness: A Systematic Review

2020 ◽  
Author(s):  
Sydney M. Dy ◽  
Julie M. Waldfogel ◽  
Danetta H. Sloan ◽  
Valerie Cotter ◽  
Susan Hannum ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Usual Care ◽  
Ambulatory Care ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

Objectives. To evaluate availability, effectiveness, and implementation of interventions for integrating palliative care into ambulatory care for U.S.-based adults with serious life-threatening chronic illness or conditions other than cancer and their caregivers We evaluated interventions addressing identification of patients, patient and caregiver education, shared decision-making tools, clinician education, and models of care. Data sources. We searched key U.S. national websites (March 2020) and PubMed®, CINAHL®, and the Cochrane Central Register of Controlled Trials (through May 2020). We also engaged Key Informants. Review methods. We completed a mixed-methods review; we sought, synthesized, and integrated Web resources; quantitative, qualitative and mixed-methods studies; and input from patient/caregiver and clinician/stakeholder Key Informants. Two reviewers screened websites and search results, abstracted data, assessed risk of bias or study quality, and graded strength of evidence (SOE) for key outcomes: health-related quality of life, patient overall symptom burden, patient depressive symptom scores, patient and caregiver satisfaction, and advance directive documentation. We performed meta-analyses when appropriate. Results. We included 46 Web resources, 20 quantitative effectiveness studies, and 16 qualitative implementation studies across primary care and specialty populations. Various prediction models, tools, and triggers to identify patients are available, but none were evaluated for effectiveness or implementation. Numerous patient and caregiver education tools are available, but none were evaluated for effectiveness or implementation. All of the shared decision-making tools addressed advance care planning; these tools may increase patient satisfaction and advance directive documentation compared with usual care (SOE: low). Patients and caregivers prefer advance care planning discussions grounded in patient and caregiver experiences with individualized timing. Although numerous education and training resources for nonpalliative care clinicians are available, we were unable to draw conclusions about implementation, and none have been evaluated for effectiveness. The models evaluated for integrating palliative care were not more effective than usual care for improving health-related quality of life or patient depressive symptom scores (SOE: moderate) and may have little to no effect on increasing patient satisfaction or decreasing overall symptom burden (SOE: low), but models for integrating palliative care were effective for increasing advance directive documentation (SOE: moderate). Multimodal interventions may have little to no effect on increasing advance directive documentation (SOE: low) and other graded outcomes were not assessed. For utilization, models for integrating palliative care were not found to be more effective than usual care for decreasing hospitalizations; we were unable to draw conclusions about most other aspects of utilization or cost and resource use. We were unable to draw conclusions about caregiver satisfaction or specific characteristics of models for integrating palliative care. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were seen as barriers to implementation. Conclusions. For integrating palliative care into ambulatory care for serious illness and conditions other than cancer, advance care planning shared decision-making tools and palliative care models were the most widely evaluated interventions and may be effective for improving only a few outcomes. More research is needed, particularly on identification of patients for these interventions; education for patients, caregivers, and clinicians; shared decision-making tools beyond advance care planning and advance directive completion; and specific components, characteristics, and implementation factors in models for integrating palliative care into ambulatory care.

Development of a statin risk communication tool for use in cancer survivors: A pilot.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 87-87
Author(s):  
Nirupa Jaya Raghunathan ◽  
Deborah Korenstein ◽  
Nassim Anderson ◽  
Roberto Adsuar ◽  
Emily S. Tonorezos ◽  
...  
Keyword(s):  
Decision Making ◽  
Usual Care ◽  
Risk Communication ◽  
Shared Decision Making ◽  
Disease Risk ◽  
Absolute Risk ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Communication Tool ◽  
Statin Use

87 Background: There are currently over a million survivors of childhood, adolescent, and young adult (CAYA) cancer in the US, many of whom were treated with radiation therapy. Chest radiation with fields including the coronary arteries is a risk factor for cardiovascular disease (CVD). Of note, survivors are often unaware of this increased CVD risk or, if they are aware, do not know how to mitigate the risk. Visual aids and communicating risk in terms of absolute risk reductions are shown to improve patients’ understanding. The Institute of Medicine recommends use of decision aids to optimize patient discussions of benefits and harms of therapies. Our goal is to develop and pilot test a statin therapy risk communication tool for use in high-risk cancer survivors to improve shared decision making and patient knowledge of coronary artery disease risk. Methods: The Statin Risk Communication Tool, modeled after the validated Statin Choice decision aid, presents a pictorial representation of absolute risk of coronary heart disease risk in survivors of CAYA cancer treated with radiation to the chest. The intervention also presents data depicting absolute risk reduction of myocardial infarction with use of statins in similar risk populations (≥7.5% baseline risk). This pilot study compares the statin risk communication tool to usual care. The post-visit assessment uses Likert-like scales to explore patient perceptions of statin use, knowledge questions to assess patient understanding of the risks and benefits of using statins and the validated 16-item Decisional Conflict Scale to measure decisional satisfaction. We will also survey participants three months after introduction of the tool to ascertain statin use and attitudes towards the discussion of statins. Results: The timeline for data collection anticipates analyzable results by August 2017. Conclusions: This risk communication tool will be assessed for acceptability, knowledge enhancement, and decisional conflict. Additionally, we will gather qualitative data regarding usual care. With this information, a future randomized controlled trial across institutions could provide information on how CAYA survivors approach shared decision making with risk communication tools. Clinical trial information: NCT02895880.

scholarly journals Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial

2019 ◽  
Vol 34 (11) ◽  
pp. 2652-2659 ◽  
Author(s):  
Tannaz Moin ◽  
O. Kenrik Duru ◽  
Norman Turk ◽  
Janet S. Chon ◽  
Dominick L. Frosch ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Diabetes Prevention ◽  
Informed Decision ◽  
Shared Decision
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