Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Diabet Med. 2021 Jun;38(6):e14419. doi: 10.1111/dme.14419. Epub 2020 Oct 20.
To explore nurses' and physicians' experiences with diabetes consultations in general and the use of dialogue tools in the Diabetes Patient-Related Outcome Measures (DiaPROM) pilot trial.
We used a qualitative explorative design by conducting semi-structured in-depth interviews with five nurses and nine physicians engaged in the DiaPROM pilot trial. The pilot trial aimed to test an intervention utilizing the patient-reported Problem Areas In Diabetes (PAID) scale and person-centred communication skills as dialogue tools in clinical consultations with adults with type 1 diabetes. We used thematic analysis to analyse the data.
We generated three themes (each including two subthemes) from the analysis of participants' experiences: (1) 'Conflicting demands and priorities' (subthemes: 'Balancing guideline recommendations with patients' main concerns' and 'Experiencing that patients need more support to disclose their emotional concerns'); (2) 'Insights about using dialogue tools' (subthemes: 'The benefits and challenges of using the PAID as a dialogue tool' and 'Communication techniques are helpful'); and (3) 'Facilitating new interventions is challenging' (subthemes: 'Unclear roles and responsibilities in the multidisciplinary teamwork' and 'The capacity sets the limit, not the willingness').
Our findings indicate that the physicians and nurses experienced substantial challenges related to time and resources in the use of dialogue tools to support people's emotional concerns in clinical diabetes consultations. Thus, there is a need for healthcare organizations to adjust priorities to focus on the emotional burden of diabetes if the multidisciplinary diabetes teams are to successfully integrate psychosocial support into routine diabetes care.
探讨护士和医生在一般糖尿病咨询方面的经验，以及在糖尿病患者相关结局测量（DiaPROM）试验中使用对话工具的情况。
我们采用定性探索性设计，对参与 DiaPROM 试验的 5 名护士和 9 名医生进行了半结构化深入访谈。该试验旨在测试一种干预措施，该措施利用患者报告的糖尿病问题领域量表（PAID）和以患者为中心的沟通技巧作为 1 型糖尿病成人临床咨询中的对话工具。我们使用主题分析来分析数据。
我们从参与者经验分析中生成了三个主题（每个主题包括两个子主题）：（1）“相互冲突的需求和优先事项”（子主题：“在平衡指南建议与患者主要关注点之间的平衡”和“患者需要更多支持来表达其情感关注”）；（2）“使用对话工具的见解”（子主题：“使用 PAID 作为对话工具的好处和挑战”和“沟通技巧很有帮助”）；（3）“促进新干预措施具有挑战性”（子主题：“多学科团队合作中的角色和责任不明确”和“能力设定限制，而不是意愿”）。
我们的研究结果表明，医生和护士在使用对话工具来支持糖尿病临床咨询中患者的情感关注方面，面临着与时间和资源相关的巨大挑战。因此，如果多学科糖尿病团队要成功地将心理社会支持纳入常规糖尿病护理，医疗保健组织需要调整优先级，关注糖尿病的情感负担。
