Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA.
Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom.
Diabetes Res Clin Pract. 2017 May;127:265-274. doi: 10.1016/j.diabres.2017.03.016. Epub 2017 Mar 22.
To investigate patient experiences during the diagnosis of type 2 diabetes mellitus (T2DM), focusing on how physician-patient communication at diagnosis influences patients' psychosocial stress and subsequent self-management and outcomes.
We surveyed adults with T2DM in 26 countries in a large cross-national study of physician-patient communication during early T2DM treatment (IntroDia®). The self-report questionnaire assessed retrospectively patient experiences during diagnosis conversations (focusing on 43 possible conversational elements, and communication quality) and potential effects on patient-reported outcomes.
Data from 3628 people with T2DM who had been prescribed oral treatment at diagnosis were analysed. Exploratory factor analyses of the conversational elements yielded four coherent, meaningful factors: Encouraging (Cronbach's α=0.86); Collaborative (α=0.88); Recommending Other Resources (α=0.75); and Discouraging (α=0.72). Patient-perceived communication quality (PPCQ) at diagnosis was positively associated with Encouraging (β=+1.764, p<0.001) and Collaborative (β=+0.347, p<0.001), negatively associated with Discouraging (β=-1.181, p<0.001) and not associated with Recommending Other Resources (β=+0.087, p=0.096), using a stable path model. PPCQ was associated with less current diabetes distress, greater current well-being and better current self-care. Conversation elements comprising factors associated with better PPCQ (Encouraging and Collaborative) were recalled more frequently by patients than elements associated with poor PPCQ (Discouraging).
Better physician-patient communication at T2DM diagnosis may contribute to subsequent greater patient well-being and self-care, and may be enhanced by greater physician use of Collaborative and Encouraging conversation elements.
研究 2 型糖尿病（T2DM）患者在诊断过程中的体验，重点探讨诊断时的医患沟通如何影响患者的心理社会压力，以及随后的自我管理和结局。
我们在一项针对早期 T2DM 治疗期间医患沟通的大型跨国研究（IntroDia®）中，调查了 26 个国家的成年 T2DM 患者。自我报告问卷回顾性评估了诊断对话期间患者的体验（重点关注 43 种可能的对话元素和沟通质量），以及对患者报告结局的潜在影响。
对已接受诊断时口服治疗的 3628 名 T2DM 患者的数据进行了分析。对对话元素进行探索性因子分析得出了四个具有内在一致性和意义的因子：鼓励（Cronbach's α=0.86）；协作（α=0.88）；推荐其他资源（α=0.75）；和劝阻（α=0.72）。诊断时的患者感知沟通质量（PPCQ）与鼓励（β=+1.764，p<0.001）和协作（β=+0.347，p<0.001）呈正相关，与劝阻（β=-1.181，p<0.001）呈负相关，与推荐其他资源（β=+0.087，p=0.096）不相关，使用稳定的路径模型。PPCQ 与当前糖尿病困扰程度较低、当前幸福感较高和当前自我护理较好相关。与更好的 PPCQ 相关的谈话元素（鼓励和协作）比与较差的 PPCQ 相关的谈话元素（劝阻）更频繁地被患者回忆起来。
在 T2DM 诊断时更好的医患沟通可能有助于随后患者的幸福感和自我护理水平的提高，并且可以通过医生更多地使用协作和鼓励的谈话元素来增强。
