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

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          Abstract

          Background

          Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. We assess a personalized web-based decision support tool.

          Design

          We randomized physicians and their patients (≥65 years of age) with type 2 diabetes to 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, 4) intervention acceptability.

          Results

          We did not find significant differences in proportions of patients that had an A1C discussion (91% intervention vs. 76% control, p=0.19). Intervention patients had larger declines in the Informed Subscale of Decisional Conflict (-20.0 vs. 0, p=0.04). There were no significant differences in proportions of patients with changes in goals (49% vs. 28%, p=0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%).

          Limitations

          Pilot trial at one academic institution.

          Conclusions

          Web-based decision support tools may be a practical approach to facilitating personalization of goals for chronic conditions.

          Trial Registration

          ClinicalTrials.govNCT02169999, https://clinicaltrials.gov/show/NCT02169999

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          Author and article information

          Journal
          8109073
          5668
          Med Decis Making
          Med Decis Making
          Medical decision making : an international journal of the Society for Medical Decision Making
          0272-989X
          1552-681X
          24 May 2016
          16 June 2016
          July 2017
          01 July 2018
          : 37
          : 5
          : 611-617
          Affiliations
          [1 ]Section of General Internal Medicine, University of Chicago, Chicago, IL USA
          [2 ]Department of Public Health Sciences, University of Chicago, Chicago, IL USA
          [3 ]Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL USA
          [4 ]Shared Decision Making Resources, Georgetown, ME, USA
          [5 ]Section of Hospital Medicine, University of Chicago, Chicago, IL USA
          Author notes
          Corresponding author: Elbert S. Huang, MD, MPH, The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA. Phone: 773-834-9143, Fax: 773-834-2238, ( ehuang@ 123456medicine.bsd.uchicago.edu )
          Article
          PMC5161732 PMC5161732 5161732 nihpa789130
          10.1177/0272989X16654142
          5161732
          27311651
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