When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?

Heisler, Michele; Vijan, Sandeep; Anderson, Robert M.; Ubel, Peter A.; Bernstein, Steven J.; Hofer, Timothy P.

doi:10.1046/j.1525-1497.2003.21132.x

Cited by 266 publications

(234 citation statements)

References 59 publications

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“…In disadvantaged populations, a variety of experiences and barriers may undermine self-management performance, including comorbid conditions such as depression or chronic pain (53)(54)(55), patient-physician communication problems (45,56), and economic barriers such as the cost of glucose test strips or medications (20,21,55,57). Moreover, in low-income neighborhoods, external barriers, such as lack of safe space to exercise (58) and the scarce availability of recommended fresh foods (59,60), may limit patients' abilities to follow lifestyle recommendations.…”

Section: Discussionmentioning

confidence: 99%

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

2006

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OBJECTIVE -Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy. RESEARCH DESIGN AND METHODS -We administered an oral questionnaire inSpanish and English to patients with type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on selfmanagement.RESULTS -The study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score Ͻ23). Diabetes self-efficacy was associated with four of the five self-management domains (P Ͻ 0.01). After adjustment, with each 10% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and foot care (1.22), but not medication adherence (1.10, P ϭ 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels. CONCLUSIONS -Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy. Diabetes Care 29:823-829, 2006T ype 2 diabetes is one of the most common diseases in the U.S., affecting Ͼ16 million individuals (1). Diabetes disproportionately affects lowincome and racial/ethnic minorities (2), and there is an urgent need to improve quality of care and lower rates of avoidable complications for these populations (3). Patients with diabetes are expected to perform daily self-management activities to help avoid diabetes-related morbidity and mortality. Self-management is a cornerstone of diabetes care, and it is believed that improving patient self-efficacy is a critical pathway to improved selfmanagement.The concept of self-efficacy is based on social cognitive theory, which describes the interaction between behavioral, personal, and environmental factors in health and chronic disease. The theory of self-efficacy pro...

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Section: Discussionmentioning

confidence: 99%

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

2006

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“…In ambulatory settings, patients' understanding of their treatment plan is highly predictive of self-management behaviors, 17,18 and agreement between a patient and his or her physician has been associated with improved medication adherence and better outcomes. [1][2][3][4] Experts have advocated for a shift in patient-physician relationships from a directive style to a more collaborative interaction.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized Patients' Understanding of Their Plan of Care

O’Leary

Kulkarni

Landler

et al. 2010

Mayo Clinic Proceedings

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OBJECTIVE:To evaluate hospitalized patients' understanding of their plan of care. PATIENTS AND METHODS:Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay). Physicians were interviewed and asked about the plan of care in the same fashion as for the patients. Two board-certified internists reviewed responses and rated patientphysician agreement on each aspect of the plan of care as none, partial, or complete agreement. RESULTS:Of 250 eligible patients, 241 (96%) agreed to be interviewed. A total of 233 (97%) of 241 physicians completed the interview, although sample sizes vary because of missing data elements. Of 239 patients, 77 (32%) correctly named at least 1 of their hospital physicians, and 143 patients (60%) correctly named their nurses. For each aspect of care, patients and physicians lacked agreement on the plan of care in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 87 (38%) of 229 instances and in 22 (10%) of 220 instances. Complete agreement on the anticipated length of stay occurred in only 85 (39%) of 218 instances.CONCLUSION: A substantial portion of hospitalized patients do not understand their plan of care. Patients' limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge.

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“…14,15 Individuals' values have a considerable impact on motivation and, therefore, on individuals' willingness to carry out self-care behaviors. 16 Thus, exploring older adults' values and preferences for diabetes care is a fundamental step toward improving the understanding of self-care barriers and the provision of quality care and is highly aligned with the recent interest in shared decision-making. [17][18][19] The purpose of this qualitative study was to explore older adults' values and preferences regarding type 2 diabetes care.…”

Section: Listening To Older Adults' Values and Preferences For Type 2mentioning

confidence: 99%

Listening to Older Adults' Values and Preferences for Type 2 Diabetes Care: A Qualitative Study

Beverly¹,

Wray²,

Lacoe³

et al. 2014

Diabetes Spectrum

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In Brief Individuals' values and preferences have a considerable impact on their motivation and, therefore, their willingness to follow treatment recommendations. This qualitative study aimed to describe older adults' values and preferences for type 2 diabetes care. Older adults valued an effective physician-patient treatment relationship and quality of life in their diabetes care. They preferred physicians who knew them as a person and were honest about their diabetes treatment and progression of the illness. When developing treatment plans, providers should assess the effect that treatment will likely have on older adults' health, while explicitly acknowledging their values and preferences for care as a prelude to better patient-centered care and potentially shared decision-making.

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When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make?

Cited by 266 publications

References 59 publications

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

Hospitalized Patients' Understanding of Their Plan of Care

Listening to Older Adults' Values and Preferences for Type 2 Diabetes Care: A Qualitative Study

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