Randomized Controlled Trial

. 2021 Nov 22;21(1):323.

doi: 10.1186/s12911-021-01673-w.

Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial

Catherine H Yu^{1

2

3}, Farid Medleg⁴, Dorothy Choi⁵, Catherine M Spagnuolo^{5

6}, Lakmini Pinnaduwage^{5

7}, Sharon E Straus^{5

7

8}, Paul Cantarutti⁹, Karen Chu¹⁰, Paul Frydrych¹¹, Amy Hoang-Kim⁵, Noah Ivers^{12

13}, David Kaplan^{13

14}, Fok-Han Leung⁵, John Maxted¹⁵, Jeremy Rezmovitz¹⁶, Joanna Sale¹⁷, Sumeet Sodhi¹⁸, Dawn Stacey^{19

20}, Deanna Telner²¹

Affiliations

¹ Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Catherine.yu@unityhealth.to.
² Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Catherine.yu@unityhealth.to.
³ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. Catherine.yu@unityhealth.to.
⁴ Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland.
⁵ Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
⁶ School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada.
⁷ Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.
⁹ Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada.
¹⁰ Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
¹¹ Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada.
¹² Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
¹³ University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
¹⁴ North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada.
¹⁵ Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada.
¹⁶ Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
¹⁷ Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
¹⁸ Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada.
¹⁹ School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
²⁰ Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada.
²¹ South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada.

PMID: 34809626
PMCID: PMC8609876
DOI: 10.1186/s12911-021-01673-w

Randomized Controlled Trial

Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial

Catherine H Yu et al. BMC Med Inform Decis Mak. 2021.

. 2021 Nov 22;21(1):323.

doi: 10.1186/s12911-021-01673-w.

Authors

Affiliations

¹ Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Catherine.yu@unityhealth.to.
² Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Catherine.yu@unityhealth.to.
³ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. Catherine.yu@unityhealth.to.
⁴ Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland.
⁵ Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
⁶ School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada.
⁷ Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.
⁹ Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada.
¹⁰ Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
¹¹ Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada.
¹² Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
¹³ University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
¹⁴ North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada.
¹⁵ Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada.
¹⁶ Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
¹⁷ Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
¹⁸ Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada.
¹⁹ School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
²⁰ Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada.
²¹ South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada.

PMID: 34809626
PMCID: PMC8609876
DOI: 10.1186/s12911-021-01673-w

Abstract

Background: MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams.

Objective: Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics.

Methods: We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups.

Results: One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments-two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors.

Conclusion: An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015.

Keywords: Cluster randomized controlled trial; Diabetes mellitus; Interprofessional care; Medical informatics; Patient decision aid; Patient education; Priority setting; Qualitative methods; Shared decision-making.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
CONSORT flow diagram. *Abbreviations*: DM, diabetes mellitus; FHT, family health team

See this image and copyright information in PMC

Cited by

Development and Early Experience of a Primary Care Learning Collaborative in a Large Health Care System.
Erickson R, Abu Dabrh AM, Chavez A, Cristiani V, DeJesus R, Laabs S, Presutti R, Rosas S, Westfall E, Witt T, Thacher T. Erickson R, et al. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221089775. doi: 10.1177/21501319221089775. J Prim Care Community Health. 2022. PMID: 35603490 Free PMC article.
Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools.
Hsu PJ, Wu CY, Kuo LC, Chen MY, Chen YL, Huang SF, Chuang PY, Jerng JS, Chen SY. Hsu PJ, et al. J Pers Med. 2022 Feb 10;12(2):256. doi: 10.3390/jpm12020256. J Pers Med. 2022. PMID: 35207744 Free PMC article.
Decision aids for people facing health treatment or screening decisions.
Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Stacey D, et al. Cochrane Database Syst Rev. 2024 Jan 29;1(1):CD001431. doi: 10.1002/14651858.CD001431.pub6. Cochrane Database Syst Rev. 2024. PMID: 38284415 Free PMC article.

References

1. Yu CH, Stacey D, Sale J, Hall S, Kaplan DM, Ivers N, et al. Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care–systematic decision aid development and study protocol. Implement Sci. 2014;9:16. - PMC - PubMed
1. Coyne I, O'Mathúna DP, Gibson F, Shields L, Leclercq E, Sheaf G. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev. 2016;11:CD008970. - PMC - PubMed
1. Duncan E, Best C, Hagen S. Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev. 2010;1:CD007297. - PMC - PubMed
1. Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect. 2006;9(1):25–36. - PMC - PubMed
1. Serrano V, Rodriguez-Gutierrez R, Hargraves I, Gionfriddo MR, Tamhane S, Montori VM. Shared decision-making in the care of individuals with diabetes. Diabet Med. 2016;33(6):742–751. - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

Grants and funding

CIHR/Canada

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial

Affiliations

Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous