Communication during patient-provider encounters regarding diabetes self-management

BACKGROUND AND OBJECTIVES: Diabetes is a common chronic illness with potentially severe complications. The risk of complica-tions is reduced through controlling blood sugar, lipids, and blood pressure. While medical intervention is important, substantial self-management on the part of patients is required to achieve good control. Patients often find self-management difficult, particularly diet and exercise modification. Clinicians face barriers as well, in-cluding lack of time, poor reimbursement, and difficulty changing their clinical practice patterns. We hypothesized that a strong focus on readily measured disease indicators competes with patients' agendas relating to symptoms and their day-to-day social context. METHODS: We recorded clinical encounters to study communi-cation about self-management in context. Recordings were tran-scribed verbatim and analyzed, primarily using a grounded theory approach. RESULTS: We found that clinicians often focused their communi-cation on quantitative measures such as blood pressure and gly-cosylated hemoglobin but that patients found it difficult to relate these measures to how they were feeling physically. Patients' social contexts influenced their self-management activities, in particular heavy caregiving responsibilities and work schedules. CONCLUSIONS: Supporting self-management of patients with dia-betes requires providers to link clinical measurements to patients' symptoms and likely outcomes. It is difficult for providers to know what support or assistance their patients need without knowledge of patients' social contexts.