What is a good consultation with a diabetologist? Perspectives from people with type 1 diabetes

Title: WHAT IS A GOOD CONSULTATION WITH A DIABETOLOGIST? PERSPECTIVES FROM PEOPLE WITH TYPE 1 DIABETES

Authors: Wad J1, Joensen L1, Schultz A1, Persson F2, Willaing I1
1Steno Diabetes Center Copenhagen , Diabetes Management Research
2Steno Diabetes Center Copenhagen, Complication Research

Background and Aims
It is well known, that people with diabetes experience psychosocial challenges related to their diabetes, such as diabetes distress. However, psychosocial challenges are often not recognized or addressed in diabetes consultations. Some studies indicate that people, who experience diabetes distress, would like to talk about these challenges with their diabetes care provider. Nevertheless, little is known about what people with type 1 diabetes expect from their diabetologist and what people with type 1 diabetes perceive as a good consultation with their diabetologist. The aim of the current study is to explore the perceptions of a good consultation with a diabetologist among adults with type 1 diabetes. Identifying possibilities for optimising the consultation and ways to facilitate a good consultation with inclusion of dialogue about psychosocial issues can be used to guide support initiatives aiming at reduced diabetes distress and improved diabetes self-management.

Design/methods
Structured qualitative interviews were conducted with 33 adults with type 1 diabetes at two specialist diabetes clinics in Denmark. The first 15 interviews were also part of a test of a dialogue tool used to enhance psychosocial and patient-centred dialogue in diabetes consultations and included questions concerning this test. The remaining 18 interviews were conducted exclusively to explore perceptions of a good consultation among people with type 1 diabetes and to explore if the test of the dialogue tool influences the participants’ perceptions of a good consultation. The interviews were performed after and in close conjunction with a consultation with a diabetologist. The interviews were conducted either face to face or as a telephone interview. The interview questions focused on desired elements of a good consultation, the most important tasks for diabetologist and patient in the consultations and what topics were easiest and most difficult to discuss. Patients were recruited from six different diabetologists at the two clinics. The age of the participants ranged from 21 to 74 years (median 50 years) and 20 out of 33 participants were men. Interviews were recorded and transcribed verbatim.

Planned analyses and preliminary results
The interviews are in the process of being analysed using systematic text condensation. First, preliminary themes were identified in the material based on reading parts of the data. The preliminary themes were discussed and two authors (JW, AS) independently coded all of the 33 interviews into meaning units related to the overall themes. One author (LJ) coded parts of the data and looked through the other authors’ coding. Subsequently the overall themes and subthemes were redefined based on comparison and discussion of the coding, resulting in consensus on overall themes with regards to the participants’ perception of a good consultation.
Analysis comparing data from participants taking part in the test of a dialogue tool vs. those only taking part in an interview is planned as a second part of the analyses.

So far results of the analysis show that perceptions of a good diabetes consultation vary greatly among the participants. Characteristics of a good consultation as described by the persons with diabetes include the following preliminary themes: a) being prepared as a patient and feeling that the doctor is well-prepared b) experiencing continuity between consultations c) experiencing mutual openness and honesty in the conversation including d) being seen and understood as an individual person e) trusting the doctor and feeling safe f) experiencing that the diabetologist understands the difficulties of managing diabetes in everyday life and g) conducting a mutual dialogue and having a collaborating relationship h) seeing the endocrinologist as an authority i) feeling properly monitored and “having the diabetologist crack the whip” j) feeling motivated and/or calm after the consultation.
Preliminary findings indicate that participants taking part in the test of the dialogue tool are more aware of the importance of being prepared for the consultation and more often highlight the importance of discussing psychosocial aspects of diabetes compared to those only taking part in an interview.

Expected outcome
The expected outcome of this study is an overview of barriers and facilitators of a good diabetes consultation from the perspective of people with type 1 diabetes. The qualitative study is expected to inform future interventions aiming at improving consultations with the diabetologist, especially with regards to making consultations patient-centred and to include dialogue on psychosocial aspects of diabetes. Furthermore, guidelines on elements that facilitate a good consultation and on ways to improve the dialogue in consultations can be developed based on the study.

Problem/questions
• What literature or theoretical framework would be relevant to include or discuss in relation to the analysis?
• Are there other factors (such as age, gender, duration of diabetes) that would be relevant to include in the analysis?
• How can the study findings be used to improve routine consultations with diabetologists?