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

Elbert S. Huang, Aviva G. Nathan, Jennifer M. Cooper, Sang Mee Lee, Na Shin, Priya M. John, William Dale, Nananda F. Col, David O. Meltzer and Marshall H. Chin

Medical Decision Making, 2017, vol. 37, issue 5, 611-617

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: type 2 diabetes; aging; personalized medicine; decision aids; decision support; chronic disease modeling; randomized trial (search for similar items in EconPapers)
Date: 2017
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:37:y:2017:i:5:p:611-617

DOI: 10.1177/0272989X16654142

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