Ledford Christy J W, Villareal Charisse, Williams Elizabeth W, Cafferty Lauren A, Jackson Jeremy T, Seehusen Dean A
Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
Diabetes Spectr. 2022 Summer;35(3):327-334. doi: 10.2337/ds21-0043. Epub 2022 Jan 25.
Effective self-management of type 2 diabetes requires receiving support, which can result from disclosing the diagnosis to a support network, including coworkers, family, and friends. As a primarily invisible disease, diabetes allows people to choose whether to disclose. This study qualitatively explores the factors that influence a person's decision to disclose diabetes to others.
Research coordinators recruited 22 interview participants, ranging in age from 32 to 64 years, whose medical records included a diagnosis code for type 2 diabetes. Participants received care from one of two U.S. medical centers. Semi-structured interviews lasted approximately 1 hour and were audio-recorded and professionally transcribed. Verification strategies such as memo-keeping and maintaining methodological coherence/congruence were used throughout analysis to promote rigor.
In patients' descriptions of their decision-making processes regarding whether to disclose their diagnosis, six themes emerged. Three motivations prompted open disclosure: ) to seek information, ) to seek social support, and ) to end the succession of diabetes, and the other three motivations prompted guarded disclosure: ) to prepare for an emergency, ) to maintain an image of health, and ) to protect employment.
Based on our findings, we recommend three communicative actions for clinicians as they talk to patients about a diabetes diagnosis. First, clinicians should talk about the benefits of disclosure. Second, they should directly address stereotypes in an effort to de-stigmatize diabetes. Finally, clinicians can teach the skills of disclosure. As disclosure efficacy increases, a person's likelihood to disclose also increases. Individuals can use communication as a tool to gain the knowledge and support they need for diabetes self-management and to interrupt the continuing multigenerational development of diabetes within their family.
2型糖尿病的有效自我管理需要获得支持，而这种支持可来自向包括同事、家人和朋友在内的支持网络透露病情诊断。作为一种主要为隐性的疾病，糖尿病患者可以选择是否透露病情。本研究定性探讨了影响一个人向他人透露糖尿病病情决定的因素。
研究协调员招募了22名访谈参与者，年龄在32岁至64岁之间，其病历中包含2型糖尿病的诊断代码。参与者接受来自美国两个医疗中心之一的治疗。半结构化访谈持续约1小时，进行了录音并由专业人员转录。在整个分析过程中使用了诸如记笔记和保持方法一致性/连贯性等验证策略，以提高严谨性。
在患者描述其关于是否透露诊断结果的决策过程中，出现了六个主题。三个动机促使他们公开透露病情：一是寻求信息，二是寻求社会支持，三是终结糖尿病的延续；另外三个动机促使他们谨慎透露病情：一是为紧急情况做准备，二是维持健康形象，三是保护工作。
基于我们的研究结果，我们建议临床医生在与患者谈论糖尿病诊断时采取三种沟通行动。首先，临床医生应该谈论透露病情的好处。其次，他们应该直接应对刻板印象，努力消除对糖尿病的污名化。最后，临床医生可以教授透露病情的技巧。随着透露病情的效果提高，一个人透露病情的可能性也会增加。个人可以将沟通作为一种工具，以获取糖尿病自我管理所需的知识和支持，并打断糖尿病在其家庭中的持续多代发展。
