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BACKGROUND/RATIONALE:
Background / Rationale:
Despite equity in access and services, studies in the VA identify racial disparities for Black Americans in the process and quality of diabetes care, adherence with diabetic treatment regimens, and patient satisfaction with services. Though effective patient-provider communication contributes to better diabetes outcomes, it is unclear how communication contributes to racial disparities in the process of care. VA studies of disparities in the diabetes process of care that address communication and decision making for Veterans use large databases, surveys, and self-report. Often, actual communication patterns are less well described and do not offer participants an opportunity to identify competing explanations for other contributing factors. Systematic comparisons of communication and decision making in interactions with diabetes outcomes and patient-provider perceptions will provide evidence for targeted, culturally tailored interventions.
OBJECTIVE(S):
Objective(s):
1.To determine the association between patient-centered communication (FHCS tool) and shared decision-making (OPTION tool) in relationship to glycemic control (A1cs).
2.To identify patterns of communication, shared decision making, and beliefs and attitudes in a sample of patient-provider pairs that represent patients with optimal, intermediate and poor glycemic control (Stance Analysis).
3.Given patients and provider pairs selected as exemplars using quantitative analysis, use speaking practices identified by qualitative analysis as predictors of glycemic control to propose elements for a targeted (as indicated: patient, provider, institutional, community) and culturally tailored intervention (CHAID analysis for prediction).
METHODS:
Methods: The proposed mixed methods study will audio record a sample of 200 patients with diabetes speaking during Primary Care visits; score and rank communication and shared decision making during health encounters between participants and their providers; and determine the association between interpersonal communication, decision making and diabetes outcomes (Quantitative). Then, in-depth interviews with 60 Veterans from the recorded sample who have best, moderate, and least effective glycemic control will identify perceptions about communication and decision making, cultural models of diabetes, as well as other possible explanations for disparities (Qualitative) for comparisons with playback interviews with their providers. Finally, resulting patterns will be analyzed to identify key elements for a future institutional, patient-provider, and/or community intervention as indicated (Integration of Mixed Methods).
FINDINGS/RESULTS:
Findings / Results: The playback interviews will identify similar and differing interpretations, cultural beliefs, competing priorities, and differences in thinking about diabetes that can affect patient understanding, decisions, trust, self-care, and outcomes. Using a CHAID statistical analysis for triangulation and prediction, this study will produce a taxonomy of patient and provider needs and best practices to propose for an evidence-based intervention to improve diabetes outcomes in Veterans with T2DM in a future trial. There are no current findings.
IMPACT:
Impact:
To improve quality of care and outcomes and reduce disparities for Black and White veterans with Type 2 diabetes mellitus (T2DM) by: 1. Identifying best practices in patient-provider communication and shared decision making associated with diabetes self-management and improved diabetes outcomes. 2. Contributing to a theory-driven patient-provider intervention to improve communication, shared decision making, and other factors that affect diabetes outcomes.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Communication and Decision Making, Quality of Care
Keywords:
Communication -- doctor-patient, Diabetes, Outcomes
MeSH Terms:
none
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