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 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.

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

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.

Utilization of a shared decision-making tool in a female infant with congenital adrenal hyperplasia and genital ambiguity

2019 ◽  
Vol 32 (6) ◽  
pp. 643-646 ◽  
Author(s):  
Reeti Chawla ◽  
Erica M. Weidler ◽  
Janett Hernandez ◽  
Gwen Grimbsy ◽  
Kathleen van Leeuwen
Keyword(s):  
Decision Making ◽  
Congenital Adrenal Hyperplasia ◽  
Shared Decision Making ◽  
Informed Decision ◽  
Female Infant ◽  
Sinus Surgery ◽  
Urogenital Sinus ◽  
Shared Decision ◽  
Adrenal Hyperplasia ◽  
Genital Ambiguity

Abstract Background Shared decision-making (SDM) is the process by which patients/families and providers make healthcare decisions together. Our team of multidisciplinary disorders of sex development (DSD) has developed an SDM tool for parents and female patients with congenital adrenal hyperplasia (CAH) and associated genital atypia. What is new Elective genital surgery is considered controversial. SDM in a patient with genital atypia will allow patient/family to make an informed decision regarding surgical intervention. Case presentation Our patient is a 2.5-year-old female with CAH and genital atypia. Initially, her parents had intended to proceed with surgery; however, after utilizing the SDM checklist, they made an informed decision to defer urogenital sinus surgery for their daughter. Conclusions We successfully utilized an SDM tool with parents of a female infant with CAH and genital atypia, which allowed them to make an informed decision regarding surgery for their daughter. Future directions include a prospective enrolling study to determine the generalizability and applicability of SDM with families of children diagnosed with CAH.

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.

Postponement of death weighed against duration of treatment and toxicity as key components in shared decision making about last line oncologic treatment.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21555-e21555
Author(s):  
Lars Henrik Jensen ◽  
Natacha D Trabjerg ◽  
Torben Hansen ◽  
Anders Kristian Moeller Jakobsen ◽  
Karina Dahl Steffensen
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Survival Time ◽  
Shared Decision Making ◽  
Number Needed To Treat ◽  
Shared Decision ◽  
Mean Survival Time ◽  
Restricted Mean Survival Time ◽  
Life Threatening ◽  
One Year

e21555 Background: Decisions about last-line treatment are challenging in oncology practice. The hope of prolonging life and reducing symptoms should be weighed against the time spend on treatment, side effects and cost. Standard oncology measures of effect such as median survival time and number needed to treat are not easily explained to patients. Postponement of symptoms or death has been shown to be superior to e.g. number needed to treat in communicating the benefit of treatment to patients. The aim of the present study was to develop a tool for shared decision making in last line treatment of patients with colorectal cancer. Methods: A literature review identified pivotal phase III trials about specific antineoplastic agents for metastatic colorectal cancer after standard treatments. Principles for determining the mean survival followed restricted mean survival time analysis. High-resolution survival curves were digitalized. Areas under the curves (AUC) were calculated for the experimental group and the control group. Results: Two drugs are approved for colorectal cancer after exposure to standard treatments; regorafenib and TAS102. AUC at one year for regorafenib was 30.1 weeks compared to 26.6 weeks for placebo resulting in a difference of 3.5 weeks. AUC at one year for TAS102 was 31.4 weeks compared to 25.7 weeks for placebo resulting in a difference of 5.7 weeks. Average time on treatment was 12 weeks for regorafenib and 14 weeks for TAS102. Risk of severe, medical significant or life-threatening (grade 3-4) adverse events increased from 14% to 54% (regorafenib) and from 52% to 69% (TAS102). Conclusions: Data was developed for shared decision making using restricted mean survival time. A patient with colorectal cancer after standard treatment can be advised: »This is a deadly disease irrespective of treatment. On average, taking medicine for about 12 weeks will postpone death for 4 to 6 weeks. Taking the medicine will cause 17 to 40 extra patients out of 100 experiencing severe or life-threatening side effects«. The concept of postponement will be further explored as a key component in patient empowerment for value based care.

scholarly journals Patient-Reported Outcome Measures may optimize shared decision-making for cancer risk management in BRCA mutation carriers

Breast Cancer ◽  
2019 ◽  
Vol 27 (3) ◽  
pp. 426-434
Author(s):  
L. S. E. van Egdom ◽  
M. A. de Kock ◽  
I. Apon ◽  
M. A. M. Mureau ◽  
C. Verhoef ◽  
...  
Keyword(s):  
Decision Making ◽  
Risk Management ◽  
Cancer Risk ◽  
Shared Decision Making ◽  
Well Being ◽  
Shared Decision ◽  
Mutation Carriers ◽  
Patient Reported ◽  
One Year ◽  
Cancer Risk Management

Abstract Purpose The aim of this study was to compare patient-reported outcomes (PROs) of BRCA1/2 mutation carriers, either after bilateral prophylactic mastectomy (BPM) or during breast surveillance, to improve shared decision-making in their cancer risk management. Methods Unaffected BRCA1/2 mutation carriers at least one year after BPM followed by immediate breast reconstruction (BPM-IBR) or one year under surveillance were eligible. After informed consent, the Hospital Anxiety and Depression Scale (HADS) and BREAST-Q were administered and compared between the different strategies. PROs were also compared to available normative data. Results Ninety-six participants were analyzed in this study and showed significant differences between strategies in age, age at genetic testing, and time since BPM or starting breast surveillance. All HADS scores were below 8 suggesting no signs of anxiety or depression in both groups. Higher mean ‘Q-physical well-being’ scores were reported by the surveillance group (81.78 [CI 76.99–86.57]) than the BPM group (76.96 [CI 73.16 – 80.75]; p = 0.011). Overall, for both questionnaires better scores were seen when compared to age-matched normative data. Conclusions No signs of anxiety or depression were seen in the surveillance or BPM-IBR group. Slightly better mean BREAST-Q scores were seen for the surveillance group in comparison to BPM-IBR, except for ‘Q-psychological well-being’. The difference in ‘Q-physical well-being’ was significantly worse for BPM-IBR. Approaches to obtain longitudinal PROs and reference values should be explored in the future, which could add value to shared decision-making in regards to breast cancer risk management in this specific patient population.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

On the evaluation of shared decision making: The Decision Evaluation Scales

2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision
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