Beyond hemoglobin A1c: a videographic analysis of conversations about quality of life and treatment burden during clinical encounters for diabetes care

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 minutes, 6 seconds (IQR: 11:16 -20:23 minutes). Thirty ve 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 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 signi cant 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.

<b>Feasibility and Acceptability of an Agenda-Setting Kit in the Care of People With Type 2 Diabetes: The QBSAFE ASK Feasibility Study</b>

“…Similarly, a prior qualitative study found that tasks such as implementing complex medication regimens and making lifestyle changes were burdensome for some people (16). Clinicians most often responded to conversation cards by asking elaborating questions, similar to results from our prior study assessing clinicians' responses to patients' concerns (5). These forms of problem-solving conversations demonstrate purposeful shared decisionmaking (17) and illustrate how shared decision-making can be an effective method for care (18).…”

Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review

“…The result of the thematic analysis represents a measurement framework for treatment burden in people with T2DM (Table 2 ). Seven themes had sufficient evidence to support their use as directly quantifiable indicators of the T2DM treatment burden, including financial [ 32 – 37 ], medication [ 35 , 36 , 38 , 39 ], administrative [ 33 , 35 – 38 , 40 , 41 ], lifestyle [ 33 , 34 , 36 , 37 , 39 , 41 , 42 ], healthcare [ 32 , 35 – 39 , 43 , 44 ], time/travel [ 32 , 33 , 36 , 43 ], and medical information [ 28 , 34 – 36 , 39 , 43 ], and were categorised as core measurement themes. Sub-themes reflecting the antecedents [ 32 , 36 , 39 , 41 , 45 ] (patient characteristics, living with T2DM) and consequences [ 32 , 33 , 35 – 37 , 41 ] (adherence to treatment, health and wellbeing and quality of life, interpersonal and social challenges) of the burden were encapsulated into associated measurement themes.…”

“…Seven themes had sufficient evidence to support their use as directly quantifiable indicators of the T2DM treatment burden, including financial [ 32 – 37 ], medication [ 35 , 36 , 38 , 39 ], administrative [ 33 , 35 – 38 , 40 , 41 ], lifestyle [ 33 , 34 , 36 , 37 , 39 , 41 , 42 ], healthcare [ 32 , 35 – 39 , 43 , 44 ], time/travel [ 32 , 33 , 36 , 43 ], and medical information [ 28 , 34 – 36 , 39 , 43 ], and were categorised as core measurement themes. Sub-themes reflecting the antecedents [ 32 , 36 , 39 , 41 , 45 ] (patient characteristics, living with T2DM) and consequences [ 32 , 33 , 35 – 37 , 41 ] (adherence to treatment, health and wellbeing and quality of life, interpersonal and social challenges) of the burden were encapsulated into associated measurement themes. Additionally, four novel themes related to T2DM treatment emerged, including health locus of control for T2DM treatment [ 33 , 34 , 36 , 37 , 41 , 43 ], insulin or injection-related burden [ 36 , 37 ], medication-related hypoglycaemia [ 28 , 34 ], and glucose meters [ 37 ].…”

Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): A Mixed-methods Systematic Review

“…All components identi ed in the preliminary conceptual framework were consistently present, and four novel themes emerged from the thematic analysis (Table S3). Finances (28-33), medication (31,32,34,35), administrative (29, 31-34, 36, 37), lifestyle (29,30,32,33,35,37,38), healthcare (28, 31-35, 39, 40), time/travel (28, 29, 32, 39), and medical information (26, 30-32, 35, 39) were classi ed into CORE measurements. Sub-themes re ecting the antecedent (28, 32, 35, 37, 41) (patient characteristics, living with T2DM) and consequence (28, 29, 31-33, 37) (adherence to treatment, health and wellbeing and quality of life, interpersonal and social challenges) of treatment burden were encapsulated into these two themes.…”