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Med Decis Making. 2017 Jul;37(5):611-617. doi: 10.1177/0272989X16654142. Epub 2016 Jun 16.

Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial.

Author information

1
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
2
Department of Public Health Sciences, University of Chicago, Chicago, IL (SML).
3
Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL (WD).
4
Shared Decision Making Resources, Georgetown, ME (NFC).
5
Section of Hospital Medicine, University of Chicago, Chicago, IL (DOM).

Abstract

BACKGROUND:

Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. The aim of this study was to assess a personalized Web-based decision support tool.

METHODS:

We randomized physicians and their patients with type 2 diabetes (≥65 years of age) to a support tool or educational pamphlet (75:25 patients). Prior to a visit, intervention patients interacted with the tool, which provided personalized risk predictions and elicited treatment preferences. Main outcomes included 1) patient-doctor communication, 2) decisional conflict, 3) changes in goals, and 4) intervention acceptability.

RESULTS:

We did not find significant differences in proportions of patients who had an A1C discussion (91% intervention v. 76% control; P = 0.19). Intervention patients had larger declines in the informed subscale of decisional conflict (-20 v. 0, respectively; P = 0.04). There were no significant differences in proportions of patients with changes in goals (49% v. 28%, respectively; P = 0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%). A limitation was that this was a pilot trial at one academic institution.

CONCLUSIONS:

Web-based decision support tools may be a practical approach to facilitating the personalization of goals for chronic conditions.

TRIAL REGISTRATION:

NCT02169999 ( https://clinicaltrials.gov/show/NCT02169999 ).

KEYWORDS:

aging; chronic disease modeling; decision aids; decision support; personalized medicine; randomized trial; type 2 diabetes

PMID:
27311651
PMCID:
PMC5161732
DOI:
10.1177/0272989X16654142
[Indexed for MEDLINE]
Free PMC Article

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