Department of Family & Community Medicine, University of California, San Francisco.
Behavioral Diabetes Institute, University of California, San Diego, USA.
Diabet Med. 2017 Dec;34(12):1658-1666. doi: 10.1111/dme.13414. Epub 2017 Jul 28.
A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.
各种针对糖尿病的干预措施——包括新型药物、设备和综合教育计划——在临床试验中已被证明是有效的。但在糖尿病护理的现实世界中，其疗效往往取决于临床医生能够在多大程度上支持糖尿病患者的个人参与和积极性，以持续、按指导使用这些新工具和新知识。尽管已经开发出许多以患者为中心的动机和行为策略，例如行动计划、动机性访谈和基于赋权的沟通，但这些策略的数量之多且明显缺乏明显差异，导致了相当大的混乱。因此，本综述的主要目标是提供一个实用的框架，对这些方案进行组织和构建，以增强其在临床护理中的更系统应用。其目的是增强临床医生的努力，以尊重的态度鼓励和支持糖尿病患者参与并积极改变行为。组织和描述所涉及的具体临床过程的三步框架基于自我决定理论，包括：临床医生为不同类型的临床接触做准备、临床医生/糖尿病患者建立关系，以及临床医生利用特定的行为工具。我们最后讨论了将该框架应用于临床护理实际情况的实际考虑因素。
