TY - JOUR
T1 - Beyond hemoglobin A1c
T2 - a videographic analysis of conversations about quality of life and treatment burden during clinical encounters for diabetes care
AU - Haider, Shanzay
AU - El Kawkgi, Omar
AU - Clark, Jennifer
AU - Breslin, Maggie
AU - Boehmer, Kasey R.
AU - Montori, Victor
AU - Lipska, Kasia
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Clinician response
KW - Diabetes
KW - Quality of life
KW - Treatment burden
UR - http://www.scopus.com/inward/record.url?scp=85109000983&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85109000983&partnerID=8YFLogxK
U2 - 10.1007/s12020-021-02757-3
DO - 10.1007/s12020-021-02757-3
M3 - Article
C2 - 34189680
AN - SCOPUS:85109000983
SN - 1355-008X
VL - 73
SP - 573
EP - 579
JO - Endocrine
JF - Endocrine
IS - 3
ER -