--- title: "Shared decision making improves asthma outcomes. | Sutter Health" description: "To compare medication adherence and clinical outcomes in adults with poorly controlled asthma randomized to treatment decision-making models or usual care." url: "https://www.sutterhealth.org/research/publications/shared-decision-making-improves-asthma-outcomes-1055312698" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Shared decision making improves asthma outcomes. # Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, & Vollmer WM; Better Outcomes of Asthma Treatment (BOAT) Study Group. _Am J Respir Crit Care Med. 181(6):566-77. doi: 10.1164/rccm.200906-0907OC. Epub 2009 Dec 17._ 2010-03-15 ## Abstract RATIONALE: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. METHODS: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. MEASUREMENTS AND MAIN RESULTS: Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. CONCLUSIONS: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with [www.clinicaltrials.gov](http://www.clinicaltrials.gov/) (NCT00217945 and NCT00149526). [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/20019345) ## Research topics - [Asthma](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Asthma%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [A new measure to assess asthma's impact on quality of life from the patient's perspective.](https://www.sutterhealth.org/research/publications/assess-qol-in-asthma-pt-point-of-view-1055312418) Wilson SR, Mulligan MJ, Ayala E, Chausow A, Huang Q, Knowles SB, Gummidipundi S, Castro M, Wise RA. J Allergy Clin Immunol. pii: S0091-6749(17)30887-4. doi: 10.1016/j.jaci.2017.02.047. \[Epub ahead of print\] 2017 Jun 01 - Publication ### [Use of a motivational interviewing-informed strategy in group orientations to improve retention and intervention attendance in a randomized controlled trial..](https://www.sutterhealth.org/research/publications/motivation-interviews-grp-orient-retain-pts-1055312502) Xiao L, Lv N, Rosas LG, Karve S, Luna V, Jameiro E, Wittels N, Ma J. Health Educ Res. 31(6):729-737. Epub 2016 Oct 10. 2016 Dec 01 - Publication ### [Association of general and central obesity and atopic and nonatopic asthma in US adults.](https://www.sutterhealth.org/research/publications/obesity-atopic-nonatopic-asthma-in-us-adults-1055312601) Ma J, Xiao L. J Asthma. 50(4):395-402. doi: 10.3109/02770903.2013.770014. Epub 2013 Feb 25. 2013 May 01 - Publication ### [Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices.](https://www.sutterhealth.org/research/publications/asthma-shared-decision-making-in-ambulatory-care-1055312730) Tapp H, Kuhn L, Alkhazraji T, Steuerwald M, Ludden T, Wilson S, Mowrer L, Mohanan S, Dulin MF. J Asthma. 51(4):380-90. doi: 10.3109/02770903.2013.876430. Epub 2014 Jan 24. 2014 May 01 - Publication ### [The Breathe Easier through Weight Loss Lifestyle (BE WELL) Intervention: a randomized controlled trial.](https://www.sutterhealth.org/research/publications/asthma-management-through-weight-loss-1055312542) Ma J, Strub P, Camargo CA Jr, Xiao L, Ayala E, Gardner CD, Buist AS, Haskell WL, Lavori PW, Wilson SR. BMC Pulm Med. 10:16. doi: 10.1186/1471-2466-10-16. 2010 Mar 24 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/shared-decision-making-improves-asthma-outcomes-1055312698#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Shared decision making improves asthma outcomes."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/shared-decision-making-improves-asthma-outcomes-1055312698#medicalscholarlyarticle","name":"Shared treatment decision making improves adherence and outcomes in poorly controlled asthma.","headline":"Shared decision making improves asthma outcomes.","abstract":"RATIONALE: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. METHODS: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. MEASUREMENTS AND MAIN RESULTS: Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P \u003c 0.0001) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P \u003c 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. CONCLUSIONS: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. 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