Wysocki Tim, James Lauren, Milkes Amy, Taylor Alex, Pierce Jessica, Brinkman William B, Carakushansky Mauri, Ross Judith, Hirschfeld Fiona
Nemours Children's Health System, Jacksonville, Florida.
Nemours Children's Hospital, Orlando, Florida.
MDM Policy Pract. 2018 Apr 18;3(1):2381468318769857. doi: 10.1177/2381468318769857. eCollection 2018 Jan-Jun.
Decision aids (DAs) are central to shared decision making (SDM) interventions, yet little is known about patients' actual DA use. Adequate utilization of DAs could optimize SDM effectiveness. Electronic DAs enable more objective tracking and analysis of actual DA utilization than do paper DAs. This report is part of an ongoing randomized controlled SDM trial enrolling adolescents with type 1 diabetes and their caregivers ( = 153) who were considering use of an insulin pump or continuous glucose monitor. Extensive stakeholder engagement guided creation of two online DAs. After completing baseline measures, 133 dyads were randomized to SDM (access to the pertinent DA) or Usual Care (clinic routines for preparing candidates for adopting these devices). Utilization data showed that 80% of caregivers and 66% of youths logged into a DA at least once; youths and caregivers, respectively, dedicated a mean of 44.7 and 55.0 minutes to website use and viewed 72.2% and 77.4% of the DA content. Median total duration from enrollment to last DA logout was 48.2 days for adolescents and 45.6 days for caregivers. Bivariate comparisons showed that non-Hispanic, Caucasian females from households with higher socioeconomic status were significantly more likely to login to the assigned DA at least once. Hierarchical multiple regression showed that adolescent males with lower levels of health literacy demonstrated fewer DA logins ( = 2.59; < 0.009), but identified no significant predictors of adolescents' or caregiver' duration of DA use or proportion of DA content viewed. Future SDM trials should seek to promote DA use, especially by non-White adolescents, perhaps with direct assistance with the initial DA login. Trials employing electronic DAs should routinely report and analyze utilization data.
决策辅助工具（DAs）是共享决策（SDM）干预措施的核心，但对于患者实际使用DAs的情况却知之甚少。充分利用DAs可以优化SDM的效果。与纸质DAs相比，电子DAs能够更客观地跟踪和分析实际的DA使用情况。本报告是一项正在进行的随机对照SDM试验的一部分，该试验招募了1型糖尿病青少年及其照顾者（n = 153），他们正在考虑使用胰岛素泵或连续血糖监测仪。广泛的利益相关者参与指导创建了两个在线DAs。在完成基线测量后，133对参与者被随机分配到SDM组（可使用相关的DA）或常规护理组（为准备采用这些设备的候选人提供诊所常规服务）。使用数据显示，80%的照顾者和66%的青少年至少登录过一次DA；青少年和照顾者分别平均花费44.7分钟和55.0分钟使用网站，并浏览了DA内容的72.2%和77.4%。从入组到最后一次退出DA的总时长中位数，青少年为48.2天，照顾者为45.6天。双变量比较显示，来自社会经济地位较高家庭的非西班牙裔白人女性登录指定DA至少一次的可能性显著更高。分层多元回归显示，健康素养水平较低的青少年男性登录DA的次数较少（β = 2.59；p < 0.009），但未发现青少年或照顾者使用DA的时长或浏览DA内容比例的显著预测因素。未来的SDM试验应寻求促进DA的使用，特别是非白人青少年，或许可以在首次登录DA时提供直接帮助。采用电子DAs的试验应定期报告和分析使用数据。
