OBJECTIVE: To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.

METHODOLOGY: A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.

RESULTS: Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.

CONCLUSION: Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.

Human ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Decision Making

BACKGROUND: Preparedness before discharge correlates with good clinical outcomes. OBJECTIVE: The study described the perception, attitudes, and perceived preparedness of patients and caregivers for discharge from the Internal Medicine wards of the University of the Philippines-Philippine General Hospital (UP-PGH). METHODS: A cross-sectional survey among 142 patients about to be discharged from the Internal Medicine wards of the Philippine General Hospital and/or their caregivers from May to June 2017 was done using a validated Filipino version of B-PREPARED, an 11-item self-administered questionnaire that measures patient preparedness for home. The questionnaire has three domains: self-care information, equipment/services, and confidence. The highest possible B-PREPARED score is 22 with higher scores indicating better discharge preparedness. Mean B-PREPARED scores were calculated. Post-hoc linear regression analysis between the scores and characteristics was performed. RESULTS: The Filipino translation of the B-PREPARED questionnaire had good internal consistency (Cronbach’s alpha 0.8). One hundred forty-two patients and caregivers participated. The mean B-PREPARED score was 14.57 ± 4.34, with a median of 15. The lowest scores were for information on available community services (1.20 ± 0.76), arranged equipment (0.83 ± 0.88), information on side effects of medications (1.19 ± 0.85), and additional information sought (0.61 ± 0.92). There was no significant correlation between preparedness and age, employment status, educational attainment, diagnosis, length of hospitalization, the number of admissions one year prior, or whether the respondent was a patient or caregiver. CONCLUSION The Filipino translation of the B-PREPARED questionnaire had good internal consistency. Although most participants reported being confident and prepared for discharge, most felt they did not receive sufficient information on side effects and available community services, and assistance in arranging for the necessary equipment for home care.