This study aimed to comparepatients’ and healthcare professionals’ (HCPs) expectationsof a patient decision aid (PDA) on insulin initiation in type 2 diabetes.
This qualitative study explored the acceptability of the PDA use in three different primary care settings in Malaysia between 2012 and 2013. We conducted 26in-depth interviews and 2 focus group discussions with HCPs and patients with type 2 diabetes who had been advised to start insulin. The PDA was given to patients in advance and it was used during the consultations to facilitate decision making. Both HCPs and patients were interviewed after completed a consultation session using the PDA. The participants include: general practitioners (n=2), medical officers (n=7), diabetes nurses (n=3),pharmacists (n=1) and Patients (n=18).A semi-structured topic guide was used to guide the interviews. The interviews were audio-recorded, transcribed verbatim, checked and managedusing Nvivo9 software using a thematic approach. The content of the PDA is summarized in Table 1.
Most of the patients viewed the PDA content as adequate, simple, clear and systematic. However, the HCPs felt thatthe PDA might not be understood by patients with low literacy who would benefit from a more simplified PDA with fewer words and more pictures. In terms of information quantity, HCPsthought theamount of information in the PDA was too much to be coveredin one consultation. This could be overcome bypatients taking it home to read.
On insulin initiation, the HCPstended to focus on information related to the benefit of insulin initiation and favoured insulin as the treatment option.Patients, on the other hand,wanted to know the impact of insulin on their quality of life, how to store insulinwhile traveling, the side effects and sources of insulin. Patients preferred to usenumbersto compare the risks and benefits ofthe treatment options. This opposed what the HCPs’ views earlier that presenting numbers in a PDA would be too complex for patients to understand.
Patients and HCPs have different expectations of a PDA. Patients wanted more practical information on insulin initiation and how insulin might affect them psychologically. It is important to considerthese issues when developing and implementinga PDA.