ZonMW Grant - Treatment Type 2 Diabetes
ZonMw grant for pilot study of shared decision-making in the treatment of type 2 diabetes
In the beginning of June 2023, the Living Lab for Sustainable Care received a ZonMw grant for a pilot study to assess the feasibility of a large cost-effectiveness study into a newly developed shared decision-making program for people with type 2 diabetes. This living lab is part of the department of Health Services Research of Maastricht University. The shared decision-making program is a complex intervention, as it consists of a patient decision aid, preparatory consultations for patients and a training for care professionals. To improve the chances that a large-scale cost-effectiveness study will bring about useful results, the program will be pilot-tested by four general practices in the Netherlands. The researchers will, among others, assess how to measure the outcomes of shared decision-making in a valid and reliable way.
Start of study: November 2023
Duration: 1,5 years
PhD-candidate Anna Tichler will conduct this study together with project leader dr. Arianne Elissen, dr. Dorijn Hertroijs, Prof. dr. Dirk Ruwaard and Prof. dr. Martijn Brouwers (MUMC+). Collaborating parties are primary care group ‘Huisarts & Zorg’, decision aid provider PATIENT+, patient organisation Diabetesvereniging Nederland, Netherlands Diabetes Federation and health insurer CZ.
Unique patient decision aid
For patients with type 2 diabetes, an ever-increasing number of treatment options is available: medication, lifestyle interventions, or combinations of both. To make well-informed decisions about the best fitting treatment, it is important that patients are made aware of the different options they have, what their pros and cons are, and how these align with what they find important. Although 1 million Dutch citizens have type 2 diabetes, a decision aid for people with this condition did not yet exist. Last February 2023, PhD-candidate Anna Tichler introduced the first evidence-based patient decision aid for type 2 diabetes together with her research team working at the Living Lab for Sustainable Care and MUMC. The decision aid was developed in close collaboration with patients, care professionals and decision aid provider PATIENT+. The decision aid is freely available (this year) and can be found here. The scientific study underpinning this aid is described here. Research shows that the use of such an aid is often hampered by the fact that patients are not well prepared for shared decision-making. Furthermore, professionals often lack trust, clarity and understanding of how to use a decision aid and engage in shared decision-making. Therefore, the patient decision aid was not introduced separately but embedded in a program accompanied by preparatory consultations for patients and a training for professionals.
Studying cost-effectiveness important, but challenging
Insight into the (cost-)effectiveness of shared decision-making in the treatment of type 2 diabetes is important to promote the adoption of a shared decision-making program. However, as this program consists of several program components, targets diverse patients, and may have an impact on many short- and long-term outcomes, the Medical Research Council (MRC) Framework points to a pilot stage before a large-scale evaluation of a program. The pilot study gives opportunities to, for instance, improve the recruitment strategy and to anticipate challenges for participation of people in research. This pilot study will pave the way for studying the effects of this shared decision-making program on for instance decision-making quality, adherence to treatment, health outcomes, and costs. In addition to this, a robust and full effectiveness study will require a process evaluation to study implementation fidelity.