A study in the January/February 2018 issue of Annals of Family Medicine observed primary care interactions and communication with patients with newly diagnosed diabetes and highlighted challenges to successful dialogue.
For the study, health-related interactions of 32 patients with newly diagnosed type 2 diabetes were videotaped and the patients were tracked as they were treated in the New Zealand health care system for about six months. The videos were used to analyze patient interactions with healthcare professionals.
The impetus for this research was recognizing that diabetes and other chronic medical conditions account for an increasing portion of the health care workload. It's also clear that in the management of such conditions, the quality of communication between clinicians and patients affects health outcomes.
The research project was conducted by Applied Research on Communication in Health (ARCH), a multidisciplinary group of researchers based in the university's primary health care and general practice department. The ARCH group studies all aspects of communication in health care, with a special focus on analyzing how people behave in real-life health care interactions.
Patients were recruited from general practices in the Auckland and Wellington regions of New Zealand. Ten practices were selected to participate based on their demographically diverse population bases and willingness to participate in intensive qualitative research. Patients were purposely recruited to create a diverse sample group based on age and ethnicity, and to provide equal numbers of men and women.
The number of consultations per patient ranged from one to 12, and the total duration of individual patient visits with health care professionals over the six-month study period ranged from 27 minutes to seven hours, 12 minutes.
Physician consultations averaged 22 minutes (ranging from six to 56 minutes), nurse consultations averaged 41 minutes (ranging from eight to 95 minutes) and dietitian consultations averaged 24 minutes (ranging from 17 to 52 minutes).
Dowell said the ARCH group's work has been particularly focused on how relatively straightforward conversational and linguistic interventions can significantly impact the quality of consultations.
"In the case of diabetes, we were aware that many different health professionals were involved in the care, and we had little idea to what extent those inputs provided an effective system of care," he said. "We were also interested in beginning the research at the starting point of diagnosis and seeing how the patient's knowledge and experience evolved over the first six months after diagnosis."
Communication Challenges, Successes
Family physicians and primary care professionals are often exquisite communicators, and this research was about enhancing good communication. The biggest communication challenge observed, Dowell said, was physicians trying to balance listening to patients' narratives with providing useful information and explanation.
According to Dowell, the quality of communication within an individual consultation led to varying degrees of effectiveness in terms of patient engagement and agreement on patient self-management, with the evolutionary pathway from the patient as novice to the patient as expert depending on both health professional and patient factors.
Understanding Patients' Individual Needs
Many patients already know they have (or are likely to develop) diabetes, from a strong family history or their perception of their own risk factor profile. They already have their own ideas about causation, management, and prognosis.Their own prediabetes stories can be helpful, since recognition of the pre-existing knowledge can be a platform to encourage patient engagement and self-management strategies."
"The work we are doing also makes us appreciate the importance of listening more and possibly talking less in consultations, and we see research of this sort as helping us understand how to improve health care one sentence at a time," Dowell concluded.