Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross‐national study (IntroDia®)1. Issue 8 (21st May 2017)

• Record Type: Journal Article
• Authors: Capehorn, M.; Polonsky, W. H.; Edelman, S.; Belton, A.; Down, S.; Gamerman, V.; Nagel, F.; Lee, J.; Alzaid, A.
• Is Part Of: Diabetic medicine. Volume 34:Issue 8(2017)
• Page Start: 1100
• Page End: 1107
• Publication Date: 2017-05-21
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13357
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician–patient communication at that time may influence the patient's subsequent self‐care and outcomes. Methods: As part of a large cross‐national study of physician–patient communication during early treatment of Type 2 diabetes (IntroDia ® ), we conducted a cross‐sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy). Results: A total of 6753 of 9247 eligible physicians completed the IntroDia ® survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self‐care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges ( r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations. Conclusions: Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self‐care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation. What's new?: IntroDia ® is the first large cross‐national study to investigate physician–patient communication during early treatment of Type 2 diabetes, when it may be particularly influential on patients' subsequent psychosocial stress, self‐care and outcomes. Results from the IntroDia ® physician survey show that physicians believe their conversations with patients at diagnosis have an important impact on patient self‐care. However, physicians experience challenges during these conversations relating to discouragement with patients and frustration with the situation at diagnosis. Interestingly, higher physician empathy is associated with a lower challenge burden. These findings may inform efforts to support physicians in their care for patients with Type 2 diabetes; however, further studies in this area are needed.