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Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized

Catherine H Yu1,2,3, Farid Medleg4, Dorothy Choi5

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Summary

This study found that using MyDiabetesPlan with interprofessional health care teams for shared decision-making (SDM) in diabetes care was feasible. However, lower-than-expected patient engagement with the tool highlights barriers to seamless integration.

Keywords:
Cluster randomized controlled trialDiabetes mellitusInterprofessional careMedical informaticsPatient decision aidPatient educationPriority settingQualitative methodsShared decision-making

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Area of Science:

  • Health Services Research
  • Digital Health Interventions
  • Patient Engagement

Background:

  • MyDiabetesPlan is a web-based tool designed to support patient-centered, diabetes-specific goal setting and shared decision-making (SDM).
  • It aims to facilitate collaboration between patients and interprofessional health care teams.

Purpose of the Study:

  • To assess the feasibility of conducting a cluster randomized controlled trial (RCT) for MyDiabetesPlan.
  • To evaluate the integration of MyDiabetesPlan into interprofessional primary care settings.

Main Methods:

  • A cluster RCT was conducted in 10 primary care clinics involving patients with diabetes and multiple comorbidities.
  • Data collection included recruitment/retention logs, financial summaries, website usage logs, and clinical encounter transcripts to assess feasibility, fidelity, and barriers/facilitators.

Main Results:

  • Recruitment and retention rates were 50.1% and 70.9%, respectively, with significant personnel hours and costs.
  • Patient completion of MyDiabetesPlan varied, with a mean completion time of 37 minutes per appointment.
  • Barriers to integration included clinician, patient, and technical factors, despite identified strategies for rapport building and individualization.

Conclusions:

  • An interprofessional approach utilizing the MyDiabetesPlan decision aid for SDM is feasible in primary care.
  • Lower-than-anticipated use of the tool and diabetes-specific appointments were observed.
  • Addressing identified facilitators and barriers is crucial for improving the seamless integration of such tools into clinical practice.