Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial

被引:19
作者
Abadie, Roberto [1 ]
Weymiller, Audrey J. [2 ]
Tilburt, Jon [1 ]
Shah, Nilay D. [3 ,4 ]
Charles, Cathy
Gafni, Amiram
Montori, Victor M. [2 ,3 ]
机构
[1] CUNY, Grad Ctr, New York, NY 10021 USA
[2] Mayo Clin, Div Endocrinol Diabet Nutr Metab & Internal Med, Rochester, MN USA
[3] Mayo Clin, Coll Med, Dept Med, Knowledge & Encounter Res Unit, Rochester, MN USA
[4] Mayo Clin, Div Hlth Care Policy & Res, Rochester, MN USA
关键词
decision aid; diabetes; randomized trial; shared decision making; video analyses;
D O I
10.1111/j.1365-2753.2008.01048.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
To describe how clinicians use decision aids. A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters. Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos. Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation. Proportion and nature of unintended use of the Statin Choice decision aid. We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters. Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.
引用
收藏
页码:492 / 497
页数:6
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