Decision coaching using a patient decision aid for youth and parents considering insulin delivery methods for type 1 diabetes: a pre/post study

Margaret L Lawson, Allyson L Shephard, Bryan Feenstra, Laura Boland, Nadia Sourial, Dawn Stacey, Margaret L Lawson, Allyson L Shephard, Bryan Feenstra, Laura Boland, Nadia Sourial, Dawn Stacey

Abstract

Background: Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method.

Methods: A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS).

Results: Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p < 0.0001; parent 37.6 vs 3.5, p < 0.0001). Youth's and parents' mean decisional conflict scores were also significantly improved for DCS subscales (informed, values clarity, support, and certainty). 92% of youth and 94% of parents were satisfied with the decision coaching and patient decision aid. Coaching sessions averaged 55 min. Parents (90%) reported that the session was the right length of time; some youth (16%) reported that it was too long.

Conclusion: Decision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.

Keywords: Decision coaching; Decisional conflict; Patient decision aid; Shared decision making; Type I diabetes.

Conflict of interest statement

Margaret Lawson is the PI of an unrelated investigator-initiated study which used insulin pumps that were purchased for the study participants from Medtronic Canada at a discounted rate. Neither the participants in this coaching study, nor their family members were participants in any of Margaret Lawson’s insulin pump studies. Other authors have no financial relationships or conflicts of interest relevant to this article to disclose. All other authors declare that they have no conflict of interest.

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Source: PubMed

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