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Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial.
J Med Internet Res. 2020 09 30; 22(9):e16984.JM

Abstract

BACKGROUND

Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM.

OBJECTIVE

This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level.

METHODS

A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used.

RESULTS

At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0).

CONCLUSIONS

Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.

Authors+Show Affiliations

St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Department of Medicine, University of Toronto, Toronto, ON, Canada.Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Southlake Regional Health Centre, Newmarket, ON, Canada.Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada.Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada.St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada. University of Toronto, Toronto, ON, Canada.University of Toronto, Toronto, ON, Canada. North York General Hospital, Toronto, ON, Canada.St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Markham Stouffville Hospital, Markham, ON, Canada.Sunnybrook Health Sciences Centre, Toronto, ON, Canada.Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada.Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

32996893

Citation

Yu, Catherine, et al. "Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid On Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial." Journal of Medical Internet Research, vol. 22, no. 9, 2020, pp. e16984.
Yu C, Choi D, Bruno BA, et al. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res. 2020;22(9):e16984.
Yu, C., Choi, D., Bruno, B. A., Thorpe, K. E., Straus, S. E., Cantarutti, P., Chu, K., Frydrych, P., Hoang-Kim, A., Ivers, N., Kaplan, D., Leung, F. H., Maxted, J., Rezmovitz, J., Sale, J., Sodhi-Helou, S., Stacey, D., & Telner, D. (2020). Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. Journal of Medical Internet Research, 22(9), e16984. https://doi.org/10.2196/16984
Yu C, et al. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid On Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res. 2020 09 30;22(9):e16984. PubMed PMID: 32996893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. AU - Yu,Catherine, AU - Choi,Dorothy, AU - Bruno,Brigida A, AU - Thorpe,Kevin E, AU - Straus,Sharon E, AU - Cantarutti,Paul, AU - Chu,Karen, AU - Frydrych,Paul, AU - Hoang-Kim,Amy, AU - Ivers,Noah, AU - Kaplan,David, AU - Leung,Fok-Han, AU - Maxted,John, AU - Rezmovitz,Jeremy, AU - Sale,Joanna, AU - Sodhi-Helou,Sumeet, AU - Stacey,Dawn, AU - Telner,Deanna, Y1 - 2020/09/30/ PY - 2019/11/15/received PY - 2020/08/11/accepted PY - 2020/05/04/revised PY - 2020/9/30/entrez PY - 2020/10/1/pubmed PY - 2021/1/26/medline KW - decision aid KW - decisional conflict KW - diabetes distress KW - diabetes mellitus KW - goals of care KW - patient assessment of chronic illness care KW - quality of life KW - randomized clinical trials KW - shared decision making SP - e16984 EP - e16984 JF - Journal of medical Internet research JO - J Med Internet Res VL - 22 IS - 9 N2 - BACKGROUND: Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE: This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS: A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS: At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS: Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078. SN - 1438-8871 UR - https://www.unboundmedicine.com/medline/citation/32996893/Impact_of_MyDiabetesPlan_a_Web_Based_Patient_Decision_Aid_on_Decisional_Conflict_Diabetes_Distress_Quality_of_Life_and_Chronic_Illness_Care_in_Patients_With_Diabetes:_Cluster_Randomized_Controlled_Trial_ L2 - https://www.jmir.org/2020/9/e16984/ DB - PRIME DP - Unbound Medicine ER -