Open Access Open Badges Study protocol

The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial

Annie LeBlanc123, Kari L Ruud123, Megan E Branda24, Kristina Tiedje25, Kasey R Boehmer1023, Laurie J Pencille1102, Holly Van Houten12, Marc Matthews8, Nilay D Shah123, Carl R May9, Barbara P Yawn67 and Victor M Montori11023*

Author Affiliations

1 Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA

2 Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

3 Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA

4 Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

5 Department of Anthropology and Sociology, Université Lumière Lyon 2, Lyon, France

6 Department of Research, Olmsted Medical Center, Rochester, MN, USA

7 Department of Family and Community Health, University of Minnesota, Minneapolis, MN, USA

8 Family Medicine, Mayo Clinic, Rochester, MN, USA

9 Faculty of Health Sciences, University of Southampton, Southampton, UK

10 Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN, USA

For all author emails, please log on.

BMC Health Services Research 2012, 12:130  doi:10.1186/1472-6963-12-130

Published: 28 May 2012



Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice.


We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms.


Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices.

Trial registration


Diabetes; Shared decision making; Cardiovascular prevention; Implementation