The reality of health care is that compared to past eras, today’s patients want to be more informed and involved in making choices about their treatments. To meet the demands of this changing environment, several “decision aids” have been developed to help diabetes educators share information with patients when choices need to be made.
“Patients are consumers of health care. They are customers. People can shop around. Patients have multiple avenues for obtaining health information,” said Anna Vannelli, MS, RD, CDE, LD, Thursday, as she presented in the breakout session “The Role of Shared Decision-Making in Diabetes: Considering the Patient’s Preferences.”
Studies show that 40 percent of patients do not follow treatment advice from healthcare professionals, leading to poor health outcomes and $290 billion in wasted resources, such as unused medications. This is driving efforts to involve patients in their healthcare decisions.
“Historically, treatment algorithms provide clinical guidance, but may not address patient preferences,” said Vannelli, a certified diabetes educator at Park Nicollet International Diabetes Center at Methodist Hospital, Minneapolis.
Shared decision-making is a process in which the clinician and the patient discuss medication options and the patient makes a decision about which medication to use. In a video presentation, Victor Montori, MD, director of the health care delivery research program at the Mayo Clinic Center for the Science of Health Care Delivery, Rochester, Minnesota, discussed shared decision-making.
“Instead of ignoring [information the patient has], the process is honoring it,” he said. Some criticize the process by claiming it requires too much time, but it only extends a 20-minute appointment by two or three minutes, Dr. Montori said.
Mayo Clinic has developed decision aids for diabetes management, including a set of cards that allows patients to pick topics of concern and easily get information to make choices. Card topics include daily routine, daily sugar testing, side effects, weight change, low blood sugar, blood sugar, and costs.
When the patients choose “weight change,” they can see how each medication option may affect weight, while “daily routine” shows how often they need to take each medication.
“This may promote adherence and help patients fit decisions into their daily routines,” Vannelli said.
The Mayo decision aids can be seen online at diabetesdecisionaid.mayoclinic.org. During a question-and-answer session, one attendee said, “The cards have transformed the way I work with my patients.”
In another video, one person with type 2 diabetes said of shared decision-making, “I have to do this for the rest of my life, so I have to figure out how to do this on my own. The physician does not know about me, so it is about working together. I have become a better participant in the process.”
The cards were developed as part of the TRICEP study, and preliminary results show increased satisfaction and knowledge compared with usual care.