3.

1 Rationale for the study

According to (IHME, 2023), type-2 diabetes is one of the most prevalent diseases across the world
that is responsible for mortality and morbidity. With the increasing numbers of people developing
the disease, the cost of providing care for patients has been increasing, for instance, the NHS (2022)
spends about £10 billion (about 10% of its budget) annually to provide care for patients living with
the disease. Heald et al. (2022) reported that the UK’s yearly mortality rate for diabetes has been
increasing since 2004 when it was 0.58% increasing to 0.82% in 2019, making diabetes a significant
risk factor for untimely deaths in the UK. Therefore, the main concern is how to provide care to
diabetes patients within the minimum range of cost possible to reduce the rate of untimely deaths
from diabetes in the UK. The rational for this research is to identify cost-effective techniques of
applying PCC within the context of evidence-based shared decision-making to provide effective care
for patients living with type-2 diabetes

3.2 Aim of the Study

The aim of this study is to summarise and synthesise research studies that examined the relationship
between SDM and care outcomes in type-2 diabetes by studying the experimental and observational
designs, and examining the relevant evidence to the care process and to clinical outcomes.

3.3 Objective of the Study

The objective of this study is to review current evidence with a view to assessing the effect of SDM in
delivering care to type-2 diabetes patients, and to provide further understanding on the impact of
evidence-based SDM the on care process and clinical outcomes.

3.4 Research Question

Does evidence-based shared decision-making improve quality of life in adults living with T2 diabetes
mellitus?

From evidence-based medicine perspective, developing the systematic review question is the most
crucial aspect of ensuring integrity in the research process (Eriksen, 2018). Hence, in formulating the
research question to ensure integrity, the PICO (Population, Intervention, Comparator, Outcome)
model was followed (Leeflang et al., 2019). According to Damen et al. (2023), the PICO model is often
used for systematic review of intervention and diagnostic studies. This forms the basis for
formulating the research question as shown in Table 1. Therefore, the research question for this
study is underpinned by the PICO model, and intervention studies will be selected for the review.

P Adults living with Type 2 diabetes mellitus

 I Person-Centred Care through an Evidence
Based Shared Decision Making

C non-person-centred usual care

O improved outcomes

Table 1: The PICO model for developing the research question

4.0 Methods

4.1 Article Selection and Quality Assessment

After deciding on the selection procedure for the articles to be selected for this study, the eligibility
criteria which specifies the inclusion and exclusion criteria for the review, and how the studies were
grouped for the synthesis need to be stated (Page et al., 2021). The inclusion and exclusion criteria
for this study are outlined as follows:

Inclusion Criteria

i. Language of construction must be in the English Language;

ii. The area of concentration of the article is within PCC, EBP, and SDM in type-2 diabetes
mellitus;
iii. Article presented the results of intervention study on personal decision aids in type-2
diabetes mellitus;
iv. Article quantitative approach;
v. Articles were published within the timeframe of 2014 – 2024.

Exclusion Criteria

i. Articles implementing systematic literature reviews, and meta-analysis;

ii. Books and book reviews;
iii. Conference articles;
iv. Article followed a qualitative approach.

4.2 Search Strategy

A search of the background literature on PCC, SDM, EBP, and type-2 diabetes was implemented to
achieve the aim and objective of the study. To get a higher yield of more accurate and
comprehensive articles (Shea et al., 2017), three database sources were selected for searching the
articles to be extracted for this study, namely: ProQuest, Scopus and Science Direct. While searching
for the articles, priority was given to randomised controlled trials followed by other quantitative and
mixed methods studies. The search strings were formulated based on the research question, and the
medical subject headings MeSH webpage, hence, the following search terms were applied:
(Evidence-based practice (MeSH terms)) AND (person-centred care (MeSH terms)) AND (decision-
making, shared (MeSH terms)) AND (type 2 diabetes mellitus AND management (MeSH terms)). The
Boolean operator ‘AND’ was applied as suggested on the MeSH web page (McKeever et al., 2015). To
ensure a rigorous research process, the articles to be selected are those that contain the relevant
subject-matters that underscore the critical research themes for this study, and that follow scientific
rigor (Tawfik et al., 2019). Further, the search strategy follows the standard protocol for evaluating
and presenting systematic reviews, and the most common applicable tool is the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) (Page et al., 2021). According to Page et al.
(2021), the PRISMA tool guides the research review procedure through a complete and transparent
process. This research follows the PRISMA guidance for the year 2020, and the procedure followed in
this study is outlined in Appendix 1.

4.3 Article Selection and Quality Assessment

Appendix 1 presents the flow diagram for the articles selected for this study. This followed the
PRISMA tool as outlined in Page et al. (2021), the eligibility criteria which specifies the inclusion and
exclusion criteria as outlined in Section 4.1 above was followed while searching through the selected
databases, namely: ProQuest, Scopus and Science Direct, a ten-year limit was set for the articles that
were selected. Upon searching the databases based on the MeSH terms highlighted above, the
following results were returned: ProQuest N = 2,960 articles; Scopus N = 31 articles; and Science
Direct N = 1788 articles, a total of 4,779 articles were returned. Based on the eligibility criteria, 4,727
articles were excluded for being out of the ten-year publication date limit and for their lack of
relevance to patient-centred shared decision-making in type-2 diabetes mellitus, as they
concentrated on other ailments, such as cardiovascular diseases, cancer, and mental health.
Furthermore, 24 articles were excluded for duplication, while 15 articles were excluded at title and
abstract stages, and 13 articles were fully read to identify their relevance in terms of person-centred
care, research design and the application of decision aids for shared decision-making in type-2
diabetes mellitus. At this stage, 7 articles were excluded for their qualitative approach to their
research. Hence, 6 articles were eligible for the review.