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Impact of adding a decision aid to patient education in adults with asthma: a randomized clinical trial
Gagne ME, Legare F, Moisan J, Boulet L-P
PLoS ONE 2017 Jan;12(1):e0170055
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Not providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma. METHODS: A parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education+DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score -37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models. RESULTS: Fifty-one participants (response rate 53%; age 44 +/- 13 years; women n = 32) were randomized either to the education+DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean (95% CI) knowledge scores increased from 21.5 (19.9 to 23.2) to 25.1 (23.1 to 27.0) in the education+DA group (p = 0.0002) and from 24.0 (22.3 to 25.7) to 26.0 (24.0 to 28.0) in the education group (p = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups. CONCLUSIONS: Education improved knowledge, decisional conflict, and asthma control whether the DA was added or not.

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