Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial
Abstract Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized con...
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2021
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oai:doaj.org-article:49363cbc6f5c47beb86ad95067d609042021-11-28T12:26:16ZIntegrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial10.1186/s12911-021-01673-w1472-6947https://doaj.org/article/49363cbc6f5c47beb86ad95067d609042021-11-01T00:00:00Zhttps://doi.org/10.1186/s12911-021-01673-whttps://doaj.org/toc/1472-6947Abstract Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015.Catherine H. YuFarid MedlegDorothy ChoiCatherine M. SpagnuoloLakmini PinnaduwageSharon E. StrausPaul CantaruttiKaren ChuPaul FrydrychAmy Hoang-KimNoah IversDavid KaplanFok-Han LeungJohn MaxtedJeremy RezmovitzJoanna SaleSumeet SodhiDawn StaceyDeanna TelnerBMCarticleShared decision-makingPriority settingPatient decision aidInterprofessional careDiabetes mellitusPatient educationComputer applications to medicine. Medical informaticsR858-859.7ENBMC Medical Informatics and Decision Making, Vol 21, Iss 1, Pp 1-12 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Shared decision-making Priority setting Patient decision aid Interprofessional care Diabetes mellitus Patient education Computer applications to medicine. Medical informatics R858-859.7 |
| spellingShingle |
Shared decision-making Priority setting Patient decision aid Interprofessional care Diabetes mellitus Patient education Computer applications to medicine. Medical informatics R858-859.7 Catherine H. Yu Farid Medleg Dorothy Choi Catherine M. Spagnuolo Lakmini Pinnaduwage Sharon E. Straus Paul Cantarutti Karen Chu Paul Frydrych Amy Hoang-Kim Noah Ivers David Kaplan Fok-Han Leung John Maxted Jeremy Rezmovitz Joanna Sale Sumeet Sodhi Dawn Stacey Deanna Telner Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| description |
Abstract Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. |
| format |
article |
| author |
Catherine H. Yu Farid Medleg Dorothy Choi Catherine M. Spagnuolo Lakmini Pinnaduwage Sharon E. Straus Paul Cantarutti Karen Chu Paul Frydrych Amy Hoang-Kim Noah Ivers David Kaplan Fok-Han Leung John Maxted Jeremy Rezmovitz Joanna Sale Sumeet Sodhi Dawn Stacey Deanna Telner |
| author_facet |
Catherine H. Yu Farid Medleg Dorothy Choi Catherine M. Spagnuolo Lakmini Pinnaduwage Sharon E. Straus Paul Cantarutti Karen Chu Paul Frydrych Amy Hoang-Kim Noah Ivers David Kaplan Fok-Han Leung John Maxted Jeremy Rezmovitz Joanna Sale Sumeet Sodhi Dawn Stacey Deanna Telner |
| author_sort |
Catherine H. Yu |
| title |
Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| title_short |
Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| title_full |
Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| title_fullStr |
Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| title_full_unstemmed |
Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| title_sort |
integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/49363cbc6f5c47beb86ad95067d60904 |
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