A treatment decision aid may increase patient trust in the diabetes specialist. the Statin Choice randomized trial

Michael R. Nannenga, Victor M. Montori, Audrey J. Weymiller, Steven A. Smith, Teresa J.H. Christianson, Sandra C. Bryant, Amiram Gafni, Cathy Charles, Rebecca J. Mullan, Lesley A. Jones, Enrique R. Bolona, Gordon H. Guyatt

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Aims : Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician. Methods : We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit. Providers and patients were blinded to the study hypothesis. Immediately after the clinical encounter, patients completed a survey including questions on trust (range 0 to total trust = 100), knowledge, and decisional conflict. Researchers reviewed videotaped encounters and assessed patient participation (using the OPTION scale) and visit length. Results : Overall mean trust score was 91 (median 97.2, IQR 86, 100). After adjustment for patient characteristics, results suggested greater total trust (trust = 100) with the decision aid [odds ratio (OR) 1.77, 95% CI 0.94, 3.35]. Total trust was associated with knowledge (for each additional knowledge point, OR 1.3, 95% CI 1.1, 1.6), patient participation (for each additional point in the OPTION scale, OR 1.1, 95% CI 1.1, 1.2), and decisional conflict (for every 5-point decrease in conflict, OR 1.5, 95% CI 1.2, 1.9). Total trust was not associated with visit length, which the decision aid did not significantly affect. There was no significant effect interaction across the trial factors. Conclusions : Preliminary evidence suggests that decision aids do not have a large negative impact on trust in the physician and may increase trust through improvements in the decision-making process.

Original languageEnglish (US)
Pages (from-to)38-44
Number of pages7
JournalHealth Expectations
Volume12
Issue number1
DOIs
StatePublished - Mar 2009

Keywords

  • Decision aids
  • Diabetes
  • Health-care delivery
  • Patient experience
  • Trust

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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