Shanzay Haider1, Omar El Kawkgi2, Jennifer Clark2, Maggie Breslin2, Kasey R Boehmer2, Victor Montori2, Kasia Lipska3. 1. Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA. 2. Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA. 3. Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA. kasia.lipska@yale.edu.
Abstract
PURPOSE: Diabetes care has largely focused on reducing the risk of complications by achieving hemoglobin A1c (HbA1c) targets; yet, whole-person care may be more effective and desirable. We sought to determine the nature of discussions about quality of life, burden of treatment, hypoglycemia, sexual function, and social support during diabetes-focused clinical encounters. METHODS: We analyzed 41 previously recorded clinical encounters with patients with type 2 diabetes from the control arms of practice-based trials of shared decision-making. Two coders evaluated videos for discussions about aspects of life with diabetes: quality of life, burden of treatment, hypoglycemia, sexual function, and social supports. When an aspect was raised, coders evaluated the nature of the conversation, clinician responses, and time spent on discussing the aspect. RESULTS: Median length of the encounter was 15 min, 6 s (IQR: 11:16-20:23 min). Overall, 35 of 41 encounters (85.4%) included some discussion of quality of life (58.5%), burden of treatment (51.2%), social support (2.4%), or hypoglycemia (9.8%). Sexual function was not discussed. On average, 4.5% (1.4-5.5%) of the encounter time involved conversations about HbA1c, whereas 15.0% (0-25%) of the encounter time was spent on some aspect of quality of life, burden of treatment, social support, or hypoglycemia. If a topic related to quality of life was raised, clinicians most often responded by acknowledging patient's concern without providing a solution (45.8%). CONCLUSIONS: A significant part of the patient-clinician encounter involves discussion of quality of life and burden of treatment, but clinicians rarely address these issues by providing solutions.
PURPOSE: Diabetes care has largely focused on reducing the risk of complications by achieving hemoglobin A1c (HbA1c) targets; yet, whole-person care may be more effective and desirable. We sought to determine the nature of discussions about quality of life, burden of treatment, hypoglycemia, sexual function, and social support during diabetes-focused clinical encounters. METHODS: We analyzed 41 previously recorded clinical encounters with patients with type 2 diabetes from the control arms of practice-based trials of shared decision-making. Two coders evaluated videos for discussions about aspects of life with diabetes: quality of life, burden of treatment, hypoglycemia, sexual function, and social supports. When an aspect was raised, coders evaluated the nature of the conversation, clinician responses, and time spent on discussing the aspect. RESULTS: Median length of the encounter was 15 min, 6 s (IQR: 11:16-20:23 min). Overall, 35 of 41 encounters (85.4%) included some discussion of quality of life (58.5%), burden of treatment (51.2%), social support (2.4%), or hypoglycemia (9.8%). Sexual function was not discussed. On average, 4.5% (1.4-5.5%) of the encounter time involved conversations about HbA1c, whereas 15.0% (0-25%) of the encounter time was spent on some aspect of quality of life, burden of treatment, social support, or hypoglycemia. If a topic related to quality of life was raised, clinicians most often responded by acknowledging patient's concern without providing a solution (45.8%). CONCLUSIONS: A significant part of the patient-clinician encounter involves discussion of quality of life and burden of treatment, but clinicians rarely address these issues by providing solutions.
Authors: Quyen Ngo-Metzger; Dara H Sorkin; John Billimek; Sheldon Greenfield; Sherrie H Kaplan Journal: J Gen Intern Med Date: 2011-10-18 Impact factor: 5.128
Authors: Puja B Parikh; Jie Yang; Steven Leigh; Kunchok Dorjee; Roopali Parikh; Nicholas Sakellarios; Hongdao Meng; David L Brown Journal: J Gen Intern Med Date: 2014-01 Impact factor: 5.128
Authors: Rebecca J Mullan; Victor M Montori; Nilay D Shah; Teresa J H Christianson; Sandra C Bryant; Gordon H Guyatt; Lilisbeth I Perestelo-Perez; Robert J Stroebel; Barbara P Yawn; Victor Yapuncich; Maggie A Breslin; Laurie Pencille; Steven A Smith Journal: Arch Intern Med Date: 2009-09-28