Physician experiences when discussing the need for additional oral medication with type 2 diabetes patients: Insights from the cross-national IntroDia® study. (February 2019)

• Record Type: Journal Article
• Authors: Down, Susan; Alzaid, Aus; Polonsky, William H.; Belton, Anne; Edelman, Steven; Gamerman, Victoria; Nagel, Friederike; Lee, Jisoo; Emmerson, James; Capehorn, Matthew
• Is Part Of: Diabetes research and clinical practice. Volume 148(2019)
• Page Start: 179
• Page End: 188
• Publication Date: 2019-02
• Subjects: Type 2 diabetes -- Physician-patient communication -- Patient survey -- Psychological well-being -- Patient-reported outcomes; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2019.01.012
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: Physician-patient communication when discussing the need for additional oral medication for type 2 diabetes (add-on) may affect the self-care of people with this condition. We aimed to investigate physicians' recalled experiences of the add-on consultation. Methods: We conducted a cross-sectional survey of physicians treating people with type 2 diabetes in 26 countries, as part of a large cross-national study of physician-patient communication during early treatment of type 2 diabetes (IntroDia®). The survey battery included novel questions about physician experiences at add-on and the Jefferson Scale of Physician Empathy. Results: Of 9247 eligible physicians, 6753 responded (73.0% response rate). Most (82%) agreed that physician-patient discussions at add-on strongly influence patients' disease acceptance and treatment adherence. Half the physicians reported ≥1 challenge in most or all add-on conversations, with a significant inverse relationship between frequency of challenges and Jefferson Scale of Physician Empathy score (standardised β coefficient: −0.313; p < 0.001). Physicians estimated that only around half their patients with type 2 diabetes follow their self-care advice. Exploratory factor analysis of physician beliefs about why their patients did not follow recommendations yielded two distinct dimensions: psychosocial barriers (e.g. depressed mood) and personal failings of the patient (e.g. not enough willpower) ( r = 0.37, p < 0.001). Conclusions: Physicians' empathy and beliefs about their patients may play a significant role in their success with the add-on conversation and, consequently, promotion of patient engagement and self-care. Although the study was limited by its retrospective, cross-sectional nature, the findings from IntroDia® may inform efforts to improve diabetes care.