Health communication experiences of emerging adults with Type 1 diabetes.

Abstract

Objective In an effort to refine a model of clinical care identifying effective communication with health care providers (HCPs) as a key skill for successful transition to adult medical care, this study explored the perspectives of emerging adults with type 1 diabetes (T1D) about factors that impact the quality and content of communication with their HCPs. Methods Twenty emerging adults with T1D were interviewed about health communication experiences with their pediatric HCP and readiness for transition to adult diabetes care. Interviews were recorded and transcribed; three raters coded transcripts using conventional content analysis for broad themes. Results Five themes emerged from the data capturing factors that influence emerging adult-HCP communication: HCP interaction style, HCP consistency, HCP support for autonomy, parental involvement in medical care, and emerging adult comfort with disclosure. Most emerging adults had not discussed transition to adult diabetes care with their HCP; some expressed confidence in their ability to transition while others expressed anxiety about the transition process. Conclusions Findings support the conceptual model of communication and inform clinical implications for working with emerging adults with T1D. Continuity of care should be prioritized with transition-age patients. Additionally, HCPs should initiate conversations about engagement in risky behaviors and transition to adult medical care and ensure emerging adults have time without parents to discuss these sensitive topics. Psychologists can enhance the transition process by facilitating effective patient-HCP communication and coaching both patients and HCPs to ask questions about risky behaviors and transition to adult medical care.

Parent and adolescent communication with healthcare professionals about Type 1 diabetes management at adolescents’ outpatient clinic appointments

“…Simms et al . also explored the retrospective accounts of emerging adults living with Type 1 diabetes in relation to their healthcare communication experiences with their paediatric healthcare professionals. Respondents viewed healthcare professional support for their increasing independence positively; this included healthcare professionals directing the conversation towards the patient rather than their parent, and including the young person in shared decision‐making processes in relation to their care.…”

“…Simms et al . suggest that taking a primary role in communication with healthcare professionals during routine appointments is a key aspect of young people taking responsibility for their diabetes care.…”

Provider-Patient Communication and Transition Readiness Among Adolescents with Type 1 Diabetes

“…Guidelines include recommending an adult provider (along with the provider's contact information), coordinating an adult provider visit prior to full transition, providing written transition material, and assessing patient self-management skills (Garvey et. al., 2012;Simms, Baumann, & Monaghan, 2017;Weissberg-Benchell, Wolpert, & Anderson, 2007). Transition readiness among adolescents has been shown to positively correlate with transition satisfaction; however, an analysis of the literature reveals that the majority of pediatric providers are not facilitating a gradual release and are failing to prepare adolescents for the transition into adult care (Garvey et.…”

“…Adolescents' ability to effectively communicate with their medical provider includes asking questions, accurately sharing information about diabetes management behaviors (e.g., frequency of insulin administration, blood glucose monitoring, and carbohydrate monitoring), and speaking openly and honestly about struggles with diabetes management and potential risk-taking behaviors (Simms et al, 2017). Higher rates of patient participation during clinic encounters positively correlates with degree of self-care and health outcomes (e.g., regimen adherence) for chronic illness management (Monaghan, Hilliard, Sweenie, & Riekert, 2013;Simms et al, 2017;Street, Makoul, Arora, & Epstein, 2009). Therefore, improving both provider and adolescent communication in the clinic setting could act as a protective factor against potential adverse effects during the transition process, by maintaining T1D adherence and healthy behaviors.…”

“…Several tools have been developed to measure provider-patient communication in the clinic setting. A great deal of the literature uses qualitative measures to assess perceived provider-patient communication, applying them through interviews and focus groups (Rao et al, 2010;Simms et al, 2017). For example, the Four Habits Model is a qualitative measure used in research and clinical practice that measures provider communication (Krupat, Frankel, Stein, & Irish, 2006;Rao et al, 2010).…”