Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
Medical Affairs, Novo Nordisk Canada, Inc, Mississauga, Ontario, Canada.
Can J Diabetes. 2022 Jun;46(4):337-345.e2. doi: 10.1016/j.jcjd.2021.11.005. Epub 2021 Dec 9.
Although multiple causes of therapeutic inertia in type 2 diabetes mellitus (T2DM) have been identified, few studies have addressed the behavioural aspects of treatment-intensification decisions among persons with type 2 diabetes (PwT2DM) and general practitioners/family practitioners (GPFPs).
A quantitative online survey was developed to capture from 300 PwT2DM and 100 GPFPs the following information: 1) perspectives on shared decision-making (SDM) related to treatment intensification, using the 9-item Shared Decision Making Questionnaire and the Shared Decision Making Questionnaire---physician version; 2) intentions to intensify treatments, using the Theory of Planned Behaviour (TPB); and 3) preferred strategies to overcome causes of therapeutic inertia in T2DM. Regression methods were applied post hoc to examine correlations with SDM scores, behavioural intentions and behaviours.
SDM scores showed a significantly lower level of perceived involvement in decision-making related to treatment intensification among PwT2DM compared with GPFPs. The TPB identified that, for PwT2DM, attitudes, perceived behavioural control and age were associated with variation in intention to intensify treatment and, for GPFPs, perceived behavioural control and not being in a shared/group practice were associated with intentions to intensify treatment. PwT2DM behaviour, measured as hesitancy to intensify treatment, was associated with age. PwT2DM want more information to become more comfortable with the treatment decision-making process, whereas GPFPs desired support from other health professionals, and more time to address issues among PwT2DM.
Strategies directed at providing GPFPs with tools/approaches to increase PwT2DM involvement in the decision-making process, such as behavioural coaching, decision aids and goal setting, may increase acceptance of treatment intensification, leading to a reduction in therapeutic inertia in T2DM.
尽管已经确定了 2 型糖尿病（T2DM）治疗惰性的多种原因，但很少有研究涉及 2 型糖尿病患者（PwT2DM）和全科医生/家庭医生（GPFPs）在治疗强化决策中的行为方面。
开发了一项定量在线调查，以从 300 名 PwT2DM 和 100 名 GPFPs 中获取以下信息：1）使用 9 项共享决策问卷和共享决策问卷-医生版，对与治疗强化相关的共同决策（SDM）的看法；2）使用计划行为理论（TPB）来衡量强化治疗的意愿；3）在 T2DM 中克服治疗惰性的首选策略。事后应用回归方法来检查与 SDM 评分、行为意图和行为的相关性。
与 GPFPs 相比，PwT2DM 在与治疗强化相关的决策中，感知到的参与度明显较低。TPB 确定，对于 PwT2DM，态度、感知行为控制和年龄与强化治疗的意愿变化相关，对于 GPFPs，感知行为控制和未进行共同/小组实践与强化治疗的意愿相关。PwT2DM 的行为，表现为不愿强化治疗，与年龄有关。PwT2DM 希望获得更多信息，以便更舒适地参与治疗决策过程，而 GPFPs 希望得到其他卫生专业人员的支持，并希望有更多时间解决 PwT2DM 中的问题。
针对提供 GPFPs 工具/方法来增加 PwT2DM 参与决策过程的策略，例如行为辅导、决策辅助和目标设定，可能会增加对治疗强化的接受程度，从而减少 T2DM 中的治疗惰性。
