Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
Patient Educ Couns. 2022 Jun;105(6):1510-1517. doi: 10.1016/j.pec.2021.09.036. Epub 2021 Sep 30.
Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations.
Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics.
Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together.
By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management.
Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
对于青少年（YP）在过渡护理中的积极参与，人们知之甚少。本研究旨在深入了解门诊医院就诊期间医患互动情况。
对荷兰 12 家医院的 61 名患有 1 型糖尿病（T1DM）的 YP（15-25 岁）进行半结构化观察（n=61）。这些咨询涉及儿科护理（n=23）、成人护理（n=17）和联合咨询（n=21）。主题数据分析主要集中在专业人员是否进行了开放、深入的对话；是否使用了动机访谈技术；是否让 YP 参与共同决策；以及是否涉及非医学话题。
除了一些很好的例子外，医疗保健专业人员与 YP 互动时普遍存在困难。他们很少关注 YP 对疾病管理的个人态度和优先事项；非医学话题仍然普遍没有得到充分关注。关于日常生活的对话往往仍然很肤浅，因为 YP 的提示没有被采纳。此外，关于个人和健康相关目标的决策通常不是共同做出的。
通过采用更以患者为中心的方法，专业人员可以赋予 YP 积极参与糖尿病管理的权力。
建议在 T1DM 中采用更以患者为中心的过渡护理，使用结构化对话模型结合工具来鼓励 YP 设定议程和共同决策。
