Background: Despite evidence-based recommendations of statins for all patients with diabetes, patients prescribed these medications often miss doses or stop the medication altogether. Research suggests that cognitive investment in the decision to take a medication may motivate patients to persist in taking it over time. We sought to determine the ability of a decision aid, Statin Choice, to help clinicians convey the evidence about the risks and benefits of statins to patients with diabetes and thus reduce conflict patients may feel about taking statins and improve pill taking action over time.

Methods: Sixteen diabetologists and 98 patients with type 2 diabetes referred to the subspecialty diabetes clinic were enrolled in a clustered randomized trial with blinded hypothesis, concealed allocation, and conducted under the intention to treat principle of decision aid vs. control. Statin Choice is a personalized decision aid that presents the estimated 10-year cardiovascular risk for the patient along with the relative risk reduction with statins and the downsides of these medications. The control intervention was a traditional educational pamphlet on cholesterol.

Results: Immediately post visit, patients in the decision aid group had greater acceptability of information scores [mean diff. 10.5 of 100 (95% CI 2.1-18.9); P=.01], lower decisional conflict scores [10.6, 95% CI 5.9, 15.4; P<0.0001], and higher trust in their physician [4.2 of 100, 95% CI 0.5-7.8; P = .025] than patients receiving the control intervention. At three months, patients were three-fold more likely to be taking statins regularly if they received the Statin Choice decision aid (94%) vs. control (79%) (P=.03).

Conclusions: A decision aid delivered during the clinical encounter enhances clinical decision-making and favorably impacts patient action on the decision. The results of this trial support the hypothesis that decision aids may enhance patient action and short term adherence to medications.