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Celia Wills, PhD, RN

Award Name Comparative Effectiveness Research Pilot Award
Award Date 07/01/2010

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Decision Support Intervention for Shared Decision-making about Depressive Symptoms in Diabetes Mellitus

The Center for Clinical and Translational Science has awarded Celia E. Wills, PhD, RN, Associate Professor & Sills Professor in Interdisciplinary Behavioral Health Nursing, with a Comparative Effectiveness Research Pilot Award for her study entitled, Decision Support Intervention for Shared Decision-making about Depressive Symptoms in Diabetes Mellitus.

The primary study goal was to evaluate if a decision support intervention would result in improved decision-making about depressive symptoms in adults with type 2 diabetes, and if these decisions would be associated with favorable changes in depressive symptoms, diabetes-specific distress and quality of life, and management of diabetes as measured by the HbA1c test that is used to gauge the extent of diabetes control.

Nationally, there is an epidemic of type 2 diabetes. People who have diabetes are also at a greater risk for depression. Some speculate the opposite, that depression might place people at higher risk for diabetes. “It’s being studied more, but it appears to be a bi-directional relationship,” Wills said. “In our study, we were looking specifically at testing a program to support choices about dealing with mild to moderate depressive symptoms as a way to improve self-management of diabetes.” Depressive symptoms can include a loss of interest in activities the person once enjoyed, lack of energy, low mood, change in sleep patterns and appetite change. These symptoms are important as they can interfere with what is necessary for a person to effectively manage their diabetes, such as exercise and healthy eating.

“Some people dealing with type 2 diabetes say, ‘I feel like I have to change everything about my life’ and it’s overwhelming for them,” Wills said. "If people are unable to make the necessary changes to their lifestyle to manage their diabetes due to depressive symptoms getting in the way, this can lead to even more discouragement.”

Depressive symptoms in the study participants were mild to moderate. “People who have mild to moderate depressive symptoms often don’t talk about their symptoms with their health care providers, but they do find their symptoms to be bothersome and that they ‘zap motivation’ for taking care of their diabetes.” Wills said.

The study intervention used in-person and telephone coaching to help the participants make choices about dealing with or treating their symptoms. It also included coaching on how to talk to health care providers about depressive symptoms. Data are still being analyzed, but initial study results for the six-month study show improved depressive symptoms and participants taking steps to improve managing diabetes in relation to the activation of study participants’ decision-making.

“Even if participants hadn’t previously thought much about what they would do about their depressive symptoms, they became ‘activated’ on thinking about it.” Wills said. “A number of people began to make decisions they carried out, and often people made multiple decisions over the course of the study on how they would manage their depressive symptoms. For example, they began conversations with their health care providers and others about their symptoms or chose to work on exercising more.”

The CCTS award helped pay personnel, such as graduate students involved in the study and for necessary supplies. Wills and her team are submitting grant applications to the NIH, the Patient-Centered Outcomes Research Institute (PCORI) and other organizations to continue their research.

“It was a very favorable experience and a great team-building project experience. We’ve done multiple presentations, are generating multiple publications and grant applications, and the students on the project have benefited hugely.” Wills said. “That’s always good, because we build the next generation of scientists.”

By Lauren Sheridan, Tuesday, July 31, 2012

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