PMID- 23129571
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20121107
LR  - 20220321
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 2
IP  - 6
DP  - 2012
TI  - Clinical effectiveness of a patient decision aid to improve decision quality and 
      glycaemic control in people with diabetes making treatment choices: a cluster 
      randomised controlled trial (PANDAs) in general practice.
LID - 10.1136/bmjopen-2012-001469 [doi]
LID - e001469
AB  - OBJECTIVE: To determine the effectiveness of a patient decision aid (PDA) to 
      improve decision quality and glycaemic control in people with diabetes making 
      treatment choices using a cluster randomised controlled trial (RCT). DESIGN: A 
      cluster RCT. SETTING: 49 general practices in UK randomised into intervention 
      (n=25) and control (n=24). PARTICIPANTS: General practices Inclusion criteria: >4 
      medical partners; list size >7000; and a diabetes register with >1% of practice 
      population. 191 practices assessed for eligibility, and 49 practices randomised 
      and completed the study. Patients People with type 2 diabetes mellitus (T2DM) 
      taking at least two oral glucose-lowering drugs with maximum tolerated dose with 
      a glycosolated haemoglobin (HbA1c) greater than 7.4% (IFCC HbA1c >57 mmol/mol) or 
      advised in the preceeding 6 months to add or consider changing to insulin 
      therapy. EXCLUSION CRITERIA: currently using insulin therapy; difficulty reading 
      or understanding English; difficulty in understanding the purpose of the study; 
      visual or cognitive impairment or mentally ill. A total of 182 assessed for 
      eligibility, 175 randomised to 95 intervention and 80 controls, and 167 
      completion and anlaysis. INTERVENTION: Brief training of clinicians and use of 
      PDA with patients in single consultation. PRIMARY OUTCOMES: Decision quality 
      (Decisional Conflict Scores, knowledge, realistic expectations and autonomy) and 
      glycaemic control (glycosolated haemoglobin, HbA1c). SECONDARY OUTCOMES: 
      Knowledge and realistic expectations of the risks and benefits of insulin therapy 
      and diabetic complications. RESULTS: Intervention group: lower total Decisional 
      Conflict Scores (17.4 vs 25.2, p<0.001); better knowledge (51.6% vs 28.8%, 
      p<0.001); realistic expectations (risk of 'hypo', 'weight gain', 'complications'; 
      81.0% vs 5.2%, 70.5% vs 5.3%, 26.3% vs 5.0% respectively, p<0.001); and were more 
      autonomous in decision-making (64.1% vs 42.9%, p=0.012). No significant 
      difference in the glycaemic control between the two groups. CONCLUSIONS: Use of 
      the PANDAs decision aid reduces decisional conflict, improves knowledge, promotes 
      realistic expectations and autonomy in people with diabetes making treatment 
      choices in general practice. ISRCTN TRIALS REGISTER NUMBER: 14842077.
FAU - Mathers, Nigel
AU  - Mathers N
AD  - Academic Unit of Primary Medical Care, Northern General Hospital, University of 
      Sheffield, Sheffield, UK.
FAU - Ng, Chirk Jenn
AU  - Ng CJ
FAU - Campbell, Michael Joseph
AU  - Campbell MJ
FAU - Colwell, Brigitte
AU  - Colwell B
FAU - Brown, Ian
AU  - Brown I
FAU - Bradley, Alastair
AU  - Bradley A
LA  - eng
GR  - IAT/I-PF/010/003/DH_/Department of Health/United Kingdom
PT  - Journal Article
DEP - 20121105
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
PMC - PMC3532975
EDAT- 2012/11/07 06:00
MHDA- 2012/11/07 06:01
PMCR- 2012/11/10
CRDT- 2012/11/07 06:00
PHST- 2012/11/07 06:00 [entrez]
PHST- 2012/11/07 06:00 [pubmed]
PHST- 2012/11/07 06:01 [medline]
PHST- 2012/11/10 00:00 [pmc-release]
AID - bmjopen-2012-001469 [pii]
AID - 10.1136/bmjopen-2012-001469 [doi]
PST - epublish
SO  - BMJ Open. 2012 Nov 5;2(6):e001469. doi: 10.1136/bmjopen-2012-001469. Print 2012.