Nurses’ and physicians’ experiences with diabetes consultations and the use of dialogue tools in the DiaPROM pilot trial: A qualitative study

Abstract

Aim 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. Methods 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. Results 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’). Conclusions 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.

Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

“…Furthermore, our data emphasised the initiation of dialogue about underlying rationales behind responses to specific items, providing further insights about the young adults' lived experience. In a related study, HCPs described striving to balance recommendations for biomedical measurements with addressing young adults' emotional concerns due to limited resources and organisational challenges 17 . However, this clinical conflict was not linked to unwillingness in applying supportive, person‐centred strategies.…”

“…We have conducted two qualitative studies alongside the DiaPROM pilot trial to inform the quantitative findings by exploring participants' and HCPs' experiences and views on feasibility and acceptability 12 . The findings from HCP experiences are published 17 . In the present study, we aimed to explore young adults' experiences of outpatient follow‐up appointments, completing electronic PROMs, and using the PAID scale during the DiaPROM pilot trial.…”

A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK

“…It may also be that the psychologically and socially based subject matter of the research has seemed more relevant to nurses, however, studies have shown that psychological and social issues are considered to be important challenges by both diabetes nurses and doctors. [56][57][58] However, while there were more nurses who participated in the study, there was a broad consensus across disciplines in relation to the identified themes and solutions. It is also important to note that a tenant of this research model is that all perspectives are Open access considered relevant, as it is the ideas that they contribute rather than the volume of contribution that informs the co-design process.…”

Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study

“…It is hypothesized that this PRO diabetes tool, due to the use of systematic patient involvement [ 31 , 32 ] in the design phase to address these factors, will have a high real-world acceptance among people with diabetes. Few studies similarly highlight a range of possible barriers to the optimal adoption and use of PRO tools in diabetes care by HCP [ 33 - 35 ]. As a national multidisciplinary group of HCPs was involved in all stages of the development of the PRO diabetes tool with attention to these issues, it is hypothesized that there will be a high level of adoption of this tool among people with diabetes.…”