Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
Kaiser Permanente Northern California Stockton Medical Offices, Stockton, CA, USA.
J Gen Intern Med. 2021 Jun;36(6):1622-1628. doi: 10.1007/s11606-020-06481-y. Epub 2021 Jan 26.
Adults diagnosed with type 2 diabetes at a younger age are at increased risk for poor outcomes. Yet, little is known about the early experiences of these individuals, starting with communication of the diagnosis. Addressing this knowledge gap is important as this initial interaction may shape subsequent disease-related perceptions and self-management.
We examined diagnosis disclosure experiences and initial reactions among younger adults with newly diagnosed type 2 diabetes.
Purposive sample of adult members of Kaiser Permanente Northern California, an integrated healthcare delivery system, diagnosed with type 2 diabetes before age 45 years.
We conducted six focus groups between November 2017 and May 2018. Transcribed audio recordings were coded by two coders using thematic analysis.
Participants (n = 41) were 38.4 (± 5.8) years of age; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified variation in diagnosis disclosure experiences, centered on four key domains: (1) participants' sense of preparedness for diagnosis (ranging from expectant to surprised); (2) disclosure setting (including in-person, via phone, via secure message, or via review of results online); (3) perceived provider tone (from nonchalant, to overly fear-centered, to supportive); and (4) participants' emotional reactions to receiving the diagnosis (including acceptance, denial, guilt, and/or fear, rooted in personal and family experience).
For younger adults, the experience of receiving a diabetes diagnosis varies greatly. Given the long-term consequences of inadequately managed diabetes and the need for early disease control, effective initial disclosure represents an opportunity to optimize initial care. Our results suggest several opportunities to improve the type 2 diabetes disclosure experience: (1) providing pre-test counseling, (2) identifying patient-preferred settings for receiving the news, and (3) developing initial care strategies that acknowledge and address the emotional distress triggered by this life-altering, chronic disease diagnosis.
年轻时被诊断患有 2 型糖尿病的成年人发生不良结局的风险增加。然而，人们对这些个体的早期经历知之甚少，从诊断沟通开始。解决这一知识空白很重要，因为这种最初的互动可能会影响随后与疾病相关的认知和自我管理。
我们研究了年轻的 2 型糖尿病患者的诊断披露经历和最初反应。
Kaiser Permanente Northern California 的成年成员，这是一个综合医疗服务系统，在 45 岁之前被诊断患有 2 型糖尿病，作为研究对象进行了选择。
我们于 2017 年 11 月至 2018 年 5 月期间进行了六次焦点小组讨论。两名编码员使用主题分析对转录的音频记录进行编码。
参与者（n=41）的年龄为 38.4（±5.8）岁；10 人自认为是拉丁裔，12 人是黑人，12 人是白人，7 人是多种族或其他种族。我们确定了诊断披露经历的变化，主要集中在四个关键领域：（1）参与者对诊断的准备程度（从预期到惊讶）；（2）披露环境（包括面对面、通过电话、通过安全信息或在线查看结果）；（3）感知提供者的语气（从漠不关心、过于恐惧到支持）；以及（4）参与者对收到诊断的情绪反应（包括接受、否认、内疚和/或恐惧，源于个人和家庭经历）。
对于年轻成年人来说，接受糖尿病诊断的经历差异很大。鉴于糖尿病管理不善的长期后果以及早期疾病控制的必要性，有效的初步披露代表了优化初始护理的机会。我们的研究结果表明了改善 2 型糖尿病披露体验的几种机会：（1）提供预测试咨询，（2）确定患者首选的接收新闻的环境，（3）制定初始护理策略，承认并解决由这种改变生活的慢性疾病诊断引发的情绪困扰。
