74th Scientific Sessions of the American Diabetes Association (ADA):

Shared Decision Making in Diabetes

Leigh H. Simmons, MD, a Primary Care Physician (PCP) in the Department of Medicine at Massachusetts General Hospital in Boston, shared her experience as a PCP treating patients with diabetes utilizing decision aids in conjunction with shared decision making. Here, EndocrineWeb.com highlights key aspects of her presentation during the American Diabetes Association’s 74th Scientific Sessions in San Francisco.

Dr. Simmons’ represented the work of Massachusetts General Hospital’s Shared Decision Making program, which has received funding from organizations, including the New England Research Institute, Gold Foundation, and Picker Institute. Decision Aids, which are part of the Shared Decision Making program, as tools that have been developed from the management of other chronic conditions.  

“A shared decision starts with patients having the right information. So I want to make sure they [the patient] know where we’re starting from and have the information they need to make an informed decision with me,” stated Dr. Simmons. Shared decision making is defined as a process that engages the patient; they are given accurate information about treatment (or no treatment) options and the expected outcomes, and then their treatment plan is tailored to the patient’s goals and concerns.

“The American Heart Association now emphasizes and uses the words shared decision making when they talk about revascularization for patients contemplating management options for their coronary disease. And in the American Diabetes Association/European Association for the Study of Diabetes guidelines of 2012, speaking about hyperglycemia management in type 2 diabetes, shared decision making with the patient may help in the selection of therapeutic options,” related Dr. Simmons.

Shared Decision Making in Diabetes Management
Most patients with diabetes are not aware of ideal blood pressure targets, although they know their A1C values and understand self-management. However, there is a “strong association of patients who have collaborative and proactive communication of shared decision making with their doctors who have better hypertension control, and diabetic patients with better hypertension control,” Dr. Simmons stated.

“Specifically with the diabetes program, over 80% of patients who watched it felt that decision making was critical in helping them make decisions about their care.” — Leigh H. Simmons, MD

It is known that patients who are given decision aids (eg, video about a condition, treatment) to make health care decisions know more about their condition, their expectations are more realistic, and their values and choices match.  For example, if a patient is very concerned about taking a medication, they are likely to choose a non-drug option. Similar choices are seen in other treatments, such as surgery.

Dr. Simmons explained how decision aids can be implemented:

  • Tell the patient the decision aid (eg, booklet, DVD) is coming (eg, via mail)
  • Tell the patient to watch the video when it arrives
  • Or make the decision aid available through patient-access to their electronic medical record
  • Or, provide a web site link, which takes the patient to the exact information they need
  • Note the decision aid in the patient’s chart for future discussion

Dr. Simmons related, “Over the years we found that the distribution has only increased. We’ve had now at this point probably 20,000 decision aids distributed—about 3,000 of those have been about diabetes care in English and Spanish.” At her hospital, 730 unique clinicians and staff in practice have prescribed a program.

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