Patient-Physician Communication and Diabetes Self-Care

Facilitators to Self-Care Communication

Despite numerous barriers to self-care communication, several factors promote self-care communication in the physician-patient relationship. For example, direct and non-accusatory communication from physicians as well as providing patients with hope for living with diabetes both support physician-patient self-care communication [45]. A recent systematic review by Sohal and colleagues [79] found that trust in physicians, the use of culturally appropriate exercise and dietary advice, and increasing family involvement improved physician-patient communication and diabetes self-care [79]. Lastly, a study by Schillinger and colleagues [80] found that physician assessment of patient recall and comprehension of new concepts during medical visits improved diabetes outcomes [80].

Patient-Physician Self-Care Communication Interventions

One of the more successful interventions for improving diabetes self-care and patient-physician communication is motivational interviewing (MI). MI is a non-judgmental communication style designed to explore a patient’s intrinsic motivation to change health behaviors [81]. Inherent to MI is the belief that motivation for change is malleable and that it can be transformed in the context of the patient-physician relationship [81]. MI is a patient-centered method designed to empower a patient’s ability and responsibility to make health-related decisions, with the physician supporting the patient’s autonomy in the process [82]. Recent meta-analyses and systematic reviews [83–87] showed that MI interventions improve self-care behaviors and glycemic control in the short-term; long-term effects of MI on self-care and glycemia remain inconclusive. More high-quality research is needed to evaluate the MI training content of these interventions in order to determine its long-term effectiveness and replicate outcomes in various healthcare settings [87].

Other studies not included in the meta-analyses and reviews found MI interventions improved self-care behaviors [88–90], glycemic control [90,91], and quality of life [91]. A qualitative study exploring diabetes patients’ experiences with MI and self-care behaviors revealed that patients’ appreciate when providers initiate discussions that result in new ways of thinking about self-care and promote a sense of well-being in patients [92]. New research utilizing patient navigators to connect diabetes patients’ to their primary care providers showed MI techniques improved patient self-efficacy and glycemic control [93]. Another study, an internet-based incentives study, found that the application of a brief MI interviewing session improved blood glucose monitoring in adolescents with type 1 diabetes [94]. Thus, creative strategies that employ MI techniques in collaboration with other members of the health care team (ie, patient navigation [93], telehealth [89], health coaching [95], internet-based tools [94]) hold promise for improving self-care and patient-physician communication. Increased collaboration with members of the health care team (eg, certified diabetes educators, nurses, dietitians, pharmacists, exercise physiologists), community health workers [96,97] and peer mentors [98,99] may help reinforce messages, promote shared decision-making, improve diabetes outcomes, increase patient satisfaction, and reduce medical costs [100].

Few other interventions have directly addressed physician-patient diabetes self-care communication. One older study examined the effectiveness of an intervention designed to increase of diabetes patients’ involvement in medical decision-making [16]. Patients randomized to the intervention arm participated in a 20-minute session prior to meeting with their physician, in which researchers reviewed their medical chart and used systematic prompts to encourage patients to negotiate medical decisions with their physician. Patients in the control arm received standard educational materials in a session of equal length. Patients in the intervention arm improved glycemia and elicited twice the amount of medical information from their physician compared to controls [16]. These findings suggest that brief interventions prior to medical appointments can improve patient communication, self-care behavior, and in turn, diabetes outcomes [16].

A recent study evaluated the effectiveness of a training program in communication skills for pediatric diabetes care providers in the UK [101, 102]. In this cluster randomized controlled trial, pediatric providers allocated to the Talking Diabetes intervention participated in web-based material and face-to-face seminars designed to prepare providers for constructive self-care conversations with patients as well as skills for promoting behavior change. The psychoeducational training emphasized shared decision-making and utilized motivational interviewing techniques [101]. Twenty-six centers and 693 young people with type 1 diabetes participated in the study [102]. At 12-month follow-up, the Talking Diabetes intervention did not demonstrate improvements in glycemic control. Further, the intervention had a negative effect on patients’ quality of life but a short-term improvement in coping [102]. Interestingly, parents of patients in the intervention arm reported greater continuity of care, which suggests that parents benefited more from the intervention than their children. Future communication interventions targeting the pediatric population should provide ongoing support to children of physicians exposed to interventions such as Talking Diabetes [102].