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Diabetes Care 26:2804-2809, 2003
© 2003 by the American Diabetes Association, Inc.

Epidemiology/Health Services/Psychosocial Research
Original Article

Decisional Attributes of Patients With Diabetes

The aspirin choice

Victor M. Montori, MD, MSC1, Sandra C. Bryant, MS2, Annette M. O’Connor, RN, MSCN, PHD3, Neal W. Jorgensen2, Erin E. Walsh4 and Steven A. Smith, MD1,5

1 Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Internal Medicine, Mayo Clinic, Rochester, Minnesota
2 Section of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
3 Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
4 Mayo Medical School, Mayo Clinic, Rochester, Minnesota
5 Division of Health Care Policy and Research and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Victor Montori, MD, W18 Mayo Clinic, 200 1st St. SW, Rochester, MN 55905

OBJECTIVE—The aim of this study was to determine personal characteristics and preferences that affect decision making (decisional attributes) in patients with diabetes. In particular, we were interested in relating these attributes to the choice of using aspirin to reduce cardiovascular risk.

RESEARCH DESIGN AND METHODS—We conducted a cross-sectional survey (70% response rate) of 206 diabetic patients (median age, 63 years; 42% women; 91% completed high school; median HbA1c, 8%) attending a tertiary care diabetes clinic. Patients answered a 42-question survey exploring decisional attributes. Medical records provided the source of clinical information. We evaluated sociodemographic, clinical, and decisional predictors of aspirin use. We also conducted a multivariable analysis with aspirin use as a dependent variable.

RESULTS—Sixty-seven percent of patients surveyed used aspirin. Patients using aspirin were at higher risk of cardiovascular disease (odds ratio 1.4, 95% CI 1.0–2.1), knew more about the benefits of aspirin (1.9, 1.4–2.6) and less about the risks of aspirin (1.4, 1.2–1.8), and were more certain about using aspirin (0.5, 0.3–0.8) than patients not using aspirin. Patients using aspirin placed a higher value on preventing cardiovascular events than on avoiding the side effects of aspirin. Patients perceived that their diabetes provider and the American Diabetes Association had greater influence on their decision to use aspirin than family members or other patients with diabetes.

CONCLUSIONS—The decisional attributes of patients with diabetes are associated with aspirin use. Decisional attributes may be the target of research and interventions to reduce underutilization to levels consistent with patient preferences.


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Copyright © 2003 by the American Diabetes Association.