Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor–patient conversations in primary care consultations in Malaysia

Syed, Ayeshah; Don, Zuraidah Mohd; Ng, Chirk Jenn; Lee, Yew Kong; Khoo, Ee Ming; Lee, Ping Yein; Abdullah, Khatijah Lim; Zainal, Azlin Zaiti

doi:10.1136/bmjopen-2016-014260

Cited by 4 publications

(4 citation statements)

References 51 publications

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“…It includes a PDA developed by a group of researchers from the University of Malaya (UM) on insulin initiation targeted at local Malaysians with poorly controlled type 2 diabetes mellitus (T2DM) despite being on multiple oral hypoglycaemic agents. This PDA was developed over the years using the conventional method and has been implemented in selected local public primary healthcare clinics (Poliklinik Kesihatan) in the Klang Valley in Malaysia 9 10…”

Section: Introductionmentioning

confidence: 99%

Cultural adaptation of a patient decision-aid for insulin therapy

et al. 2020

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IntroductionPatient decision-aids (PDAs) support patients in selecting evidence-based treatment options. PDA is useful only if the user understands the content to make personalised decisions. Cultural adaptation is a process of adjusting health messages so that the information is accurate, relevant and understandable to users from a different population. A PDA has been developed to assist Malaysian patients with secondary drug failure to initiate insulin therapy to control their type 2 diabetes mellitus (T2DM). Likewise, patients with T2DM in neighbouring Singapore face similar barriers in commencing insulin treatment, which a PDA may facilitate decision-making in selecting personalised therapy.ObjectiveThe study aimed to explore the views and perceptions of Singaporean primary care providers on the Malaysia PDA to initiate insulin therapy and described the cultural adaptation process used in the design and development of a new PDA, which would be trialled in a Singapore primary healthcare institution.MethodQualitative research method was deployed to conduct one-to-one in-depth interviews of the healthcare providers at the trial site (SingHealth Polyclinics—SHP), including six primary care physicians and four nurses to gather their views and feedbacks on the Malaysian PDA. The interviews were transcribed, audited and analysed (standard content analysis) to identify themes relating to the content, layout, concerns of the original PDA and suggestions to the design of the new SHP PDA.ResultsCultural adaptation of the new PDA includes change to the overall design, graphics (including pictograms), presentation styles, additional contextualised content (personalisation, subheadings, cost and treatment option), modified phrasing of the subtitles and concerns (choice of words) relevant to the new users.ConclusionA PDA on insulin therapy underwent cultural adaptation before its implementation in another population in a neighbouring country. Its relevance and effectiveness will be evaluated in future research.

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Section: Introductionmentioning

confidence: 99%

Cultural adaptation of a patient decision-aid for insulin therapy

et al. 2020

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“…The included studies were published between 2001 and 2020. Four of the 18 studies were undertaken in Australia [ 22–25 ], three in the USA [ 26–28 ], two in Sweden [ 29 , 30 ], Norway [ 31 , 32 ], UK [ 33 , 34 ], New Zealand [ 35 , 36 ], and Belgium [ 37 , 38 ], and one in Malaysia [ 39 ]. For data collection, semi-structured interviews, focus group interviews, telephone interviews, video recordings, and observations were used.…”

Section: Resultsmentioning

confidence: 99%

“…Of the included studies, there was an underrepresentation of studies, including patients with COPD because no studies contained knowledge on the involvement of patients with COPD from the patients’ perspectives and only two from GPs’ perspectives [ 32 , 36 ]. The remaining studies reported on the involvement of patients with TD2 from either the patients’ [ 22 , 23 , 26 , 29 , 31 , 33 , 38 ] or GPs’ [ 24 , 30 , 32 , 36 , 37 ] views or a combination thereof [ 25 , 27 , 28 , 34 , 35 , 39 ]. In Table 2 , the included studies’ characteristics are presented.…”

Section: Resultsmentioning

confidence: 99%

Patient involvement in the encounter between general practice and patients with a chronic disease. Results of a scoping review focusing on type 2 diabetes and obstructive pulmonary disease

Titlestad

Marcussen

Rasmussen

et al. 2022

European Journal of General Practice

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Introduction Research has shown improved health outcomes when patients are involved in managing their health conditions and when their individual needs are considered. Objectives This scoping review aimed to map the existing research regarding chronic disease patients’ involvement in their encounters with general practice, with a specific focus on patients with Type 2 diabetes (TD2) or chronic obstructive pulmonary disease (COPD) and from the perspectives of both general practitioners and patients. Methods Studies of any design, date, and language were included. A systematic search was conducted using the following databases: Medline, CINAHL, PsycInfo, Scopus, and EMBASE from August until October 2020 and renewed September 2021. Data were systematically charted by the following study characteristics: bibliographic aims; study aims; setting; area of interest; results; conclusion. Results Eighteen studies were included; they conducted qualitative methods, surveys or mixed methods. From the patients’ perspectives, the importance of being more involved in treatment discussions during consultations as well as a friendly environment, was underscored. A good relationship and relational continuity make it easier for patients to be more involved in treatment decisions. From the general practitioner (GP) perspectives, they mentioned their high workload, long-standing relationships, knowledge about the patients and prepared patients as factors influencing their ability to involve patients in treatment discussions. Conclusion A good GP–patient relationship was considered an important aspect to providing and facilitating for involvement of patients with COPD or TD2. Scoping review registration: https://osf.io/ynqt2

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“…Insulin therapy may be required to achieve adequate glycaemic control in some patients, they so called secondary failure to OHA. Some Patients are hesitating to continue insulin, and some have adverse reaction to insulin 7 . There are guidelines existed for shifting patient's treatment regimen form OHA to Insulin ,8,9 but no such guidelines for shifting a patient from insulin to OHA therapy.…”

Section: Introductionmentioning

confidence: 99%

Successful Switch Over From Insulin Therapy to Ayurveda Medication in a Newly Diagnosed Diabetic Patient: A Case Study

Panda¹,

Ratha²,

Pandurang³

et al. 2018

Int. J. Res. Ayurveda Pharm.

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A 51-year male patient came to our OPD, complaining of blurry vision, generalised weakness and headache for one week. His body weight was 62 Kg, BMI 23.6, blood pressure was 130/86 mm of Hg, fasting blood sugar was 347 mg/dl, PPBS-413 mg/dl, and HbA1C was 16% total cholesterol-241, triglyceride-300, and renal profile within normal limits. Patient was started with human insulin 12 units before lunch and 8 units before dinner for one month. Patient showed dissatisfaction in insulin therapy and willing to switch over to Ayurveda medication. We planned treatment for pacify Vata by downward movement (Vatanulomana) and vitalisation (Santarpana chikitsa). We administered Triphala Churna with lukewarm water for Vatanulomana (pacify Vata); Dhanvantar Ghrita and Vasant Kusumakara Rasa (VKR) for Santarpana (vitalisation) and AYUSH-82 as a hyperglycaemic agent for total 21 weeks step by step. All these treatment regimens increase the C peptide level, lowering the HbA1C from 9% to 5.4 % which is a clear indication of restore the beta cell function and successful in shifting ayurveda medication from insulin. Further study for large number of population is suggested.

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Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor–patient conversations in primary care consultations in Malaysia

Cited by 4 publications

References 51 publications

Cultural adaptation of a patient decision-aid for insulin therapy

Cultural adaptation of a patient decision-aid for insulin therapy

Patient involvement in the encounter between general practice and patients with a chronic disease. Results of a scoping review focusing on type 2 diabetes and obstructive pulmonary disease

Successful Switch Over From Insulin Therapy to Ayurveda Medication in a Newly Diagnosed Diabetic Patient: A Case Study

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