Principle 2. Information Alone Is Insufficient to Improve
Patient Outcomes: Shared decision making should target evidence-
based educational interventions that promote skill
development. A review of adult asthma self-management education
showed that information-only interventions did not
have a significant effect21; “difficult asthma” psycho-education
reduced hospitalizations in adults and children and improved
symptoms in children.22 In a meta-analysis of diabetes selfmanagement
education, didactic patient education by itself was
not sufficient to improve health outcomes.23 In pediatric asthma,
education, as compared with usual care, decreased the
mean number of hospitalizations and emergency department
visits, with more visits and interactive learning producing better
outcomes.24 Similarly, successful educational interventions
for children with asthma incorporated skill-based training—
either symptom-attack management or peak-flow training.25
Warsi et al., who reviewed a range of self-management interventions,
found evidence of reduced glycosylated hemoglobin
(A1C) in diabetes, reduced systolic blood pressure in hypertension,
and fewer attacks in asthma but nonsignificant changes in
arthritis.26 Interventions that involved face-to-face contact were
associated with better outcomes. The authors noted that diabetes,
hypertension, and asthma are conditions for which skills
can be taught in diet, blood sugar control, and medication
management, as opposed to arthritis, for which goals are less
easy to define.