Document Detail


Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial.
MedLine Citation:
PMID:  19366386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe how clinicians use decision aids. BACKGROUND: 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. DESIGN: Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos. SETTING AND PARTICIPANTS: 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. MAIN OUTCOME MEASURES: Proportion and nature of unintended use of the Statin Choice decision aid. RESULTS: 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. CONCLUSIONS: 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.
Authors:
Roberto Abadie; Audrey J Weymiller; Jon Tilburt; Nilay D Shah; Cathy Charles; Amiram Gafni; Victor M Montori
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-04-02
Journal Detail:
Title:  Journal of evaluation in clinical practice     Volume:  15     ISSN:  1365-2753     ISO Abbreviation:  J Eval Clin Pract     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-15     Completed Date:  2009-09-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9609066     Medline TA:  J Eval Clin Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  492-7     Citation Subset:  IM    
Affiliation:
Health Sciences Doctoral Programs, Public Health, Graduate Center, City University of New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Choice Behavior*
Decision Support Systems, Clinical*
Diabetes Mellitus
Health Personnel*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Video Recording
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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