Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Eval Clin Pract. 2022 Jun;28(3):445-453. doi: 10.1111/jep.13666. Epub 2022 Feb 12.
RATIONALE, AIMS AND OBJECTIVES: Type 2 diabetes (T2D) is an archetypical chronic condition of significant prevalence. Yet the concept of cure in the context of T2D reveals an interplay between the medical imagination and clinical realities that can shift the course of a patient's care. There are two domains in which cure is sociologically constructed: the professional domain occupied by clinicians treating people with T2D, and the lay domain occupied by T2D patients. Lay epistemologies of cure tend to be focused on modifying the experience of having T2D, while professional epistemologies tend to focus on modifying the disease through medical treatment. The objective of this study is to explore the role of the concept of cure in the context of type 2 diabetes, a model for chronic disease.
Through surveys and interviews of T2D patients, providers and researchers at an urban academic medical centre, I explore the perspectives and attitudes each group have towards the concept of cure in T2D. Semi-structured interviews of T2D professionals and patient surveys consisting of free response questions and Likert scale items were thematically analysed for perspectives on cure in T2D.
Sixteen T2D patients met inclusion criteria and consented to the survey and ten T2D professionals were interviewed. Cure is conceived of heterogeneously both within and between epistemologies. Patients carry hopes of cure predicated on eliminating the unpleasant experiences of T2D and its treatments, while T2D professionals tend to avoid invoking the concept of cure, at least to patients, on grounds of clinical uncertainty. However, the concept of cure is a significant motivator of treatment in both lay and professional epistemologies.
Different viewpoints on cure in T2D present an opportunity for shared meaning and decision making between patients and their providers that can frame the best possible outcome for patient care.
2 型糖尿病（T2D）是一种具有显著流行率的典型慢性疾病。然而，在 T2D 背景下的治愈概念揭示了医学想象和临床现实之间的相互作用，这种相互作用可以改变患者治疗的进程。在两个领域中，治愈是在社会学上构建的：一个是由治疗 T2D 患者的临床医生占据的专业领域，另一个是由 T2D 患者占据的非专业领域。非专业的治愈认识论往往侧重于改变患有 T2D 的体验，而专业的认识论则倾向于通过医学治疗来改变疾病。本研究的目的是探讨在 2 型糖尿病这一慢性疾病模型的背景下，治愈概念的作用。
通过对城市学术医疗中心的 T2D 患者、提供者和研究人员进行调查和访谈，我探讨了每个群体对 T2D 中治愈概念的观点和态度。对 T2D 专业人员进行半结构化访谈，并对 T2D 患者进行调查，调查内容包括自由回答问题和李克特量表项目，对 T2D 中治愈的观点进行了主题分析。
符合纳入标准并同意参与调查的 16 名 T2D 患者和 10 名 T2D 专业人员接受了访谈。在不同的认识论中，治愈的概念既有内部的异质性，也有外部的异质性。患者怀有治愈的希望，希望消除 T2D 及其治疗带来的不愉快体验，而 T2D 专业人员则倾向于避免在临床不确定的情况下向患者提及治愈的概念，尽管治愈的概念在患者和提供者的非专业认识论中都是治疗的重要动力。
T2D 中不同的治愈观点为患者及其提供者之间提供了一个共享意义和决策的机会，可以为患者护理的最佳结果提供框架。
