Elbert S. Huang , MD, MPH 1 , Aviva G. Nathan , MPH 1 , Jennifer M. Cooper , MPH 1 , Sang Mee Lee , PhD 2 , Na Shin 1 , Priya M. John , MPH 1 , William Dale , MD, PhD 3 , Nananda F. Col , MD, MPP, MPH 4 , David O. Meltzer , MD, PhD 5 , Marshall H.Chin , MD, MPH 1
16 June 2016
Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. We assess a personalized web-based decision support tool.
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.
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%).
Web-based decision support tools may be a practical approach to facilitating personalization of goals for chronic conditions.