The impact of training healthcare professionals’ communication skills on the clinical care of diabetes and hypertension: a systematic review and meta-analysis

Abstract

Background Diabetes and hypertension care require effective communication between healthcare professionals and patients. Training programs may improve the communication skills of healthcare professionals but no systematic review has examined their effectiveness at improving clinical outcomes and patient experience in the context of diabetes and hypertension care. Methods We conducted a systematic review of randomized controlled trials to summarize the effectiveness of any type of communication skills training for healthcare professionals to improve diabetes and/or hypertension care compared to no training or usual care. We searched Medline, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception to August 2020 without language restrictions. Data on the country, type of healthcare setting, type of healthcare professionals, population, intervention, comparison, primary outcomes of glycated hemoglobin (HbA1c) and blood pressure, and secondary outcomes of quality of life, patient experience and understanding, medication adherence and patient-doctor relationship were extracted for each included study. Risk of bias of included studies was assessed by Cochrane risk of bias tool. Results 7011 abstracts were identified, and 19 studies met the inclusion criteria. These included a total of 21,762 patients and 785 health professionals. 13 trials investigated the effect of communication skills training in diabetes management and 6 trials in hypertension. 10 trials were at a low risk and 9 trials were at a high risk of bias. Training included motivational interviewing, patient centred care communication, cardiovascular disease risk communication, shared decision making, cultural competency training and psychological skill training. The trials found no significant effects on HbA1c (n = 4501, pooled mean difference -0.02 mmol/mol, 95% CI -0.10 to 0.05), systolic blood pressure (n = 2505, pooled mean difference -2.61 mmHg, 95% CI -9.19 to 3.97), or diastolic blood pressure (n = 2440, pooled mean difference -0.06 mmHg, 95% CI -3.65 to 2.45). There was uncertainty in whether training was effective at improving secondary outcomes. Conclusion The communication skills training interventions for healthcare professionals identified in this systematic review did not improve HbA1c, BP or other relevant outcomes in patients with diabetes and hypertension. Further research is needed to methodically co-produce and evaluate communication skills training for chronic disease management with healthcare professionals and patients.

The experiences of people with type 2 diabetes in communicating with general practitioners in China – a primary care focus group study

“…Communication skills training for GPs in China should ensure that such areas are addressed, and patient tools and communication aids may further facilitate these conversations. Communication of this type must also offer a tailored discussion, adapting to the particular risk profile of the patient and providing relevant management advice that takes the patient perspective into account [ 17 , 27 ].…”

“…This qualitative focus group study is part of a programme of research, aimed to understand the communication experiences in type 2 diabetes care in China, and related training needs. A review of the literature highlighted the importance of effective communication between healthcare providers and diabetes patients to ensuring optimal diabetes care [ 15 – 17 ]. Also, the patient–provider relationship has a strong bearing on patients’ adherence to treatment [ 18 , 19 ].…”

Using a mixed method to identify communication skills training priorities for Chinese general practitioners in diabetes care

“…Key elements for successful communication training were identified including teaching theories, appropriate training content, and training methods. Research gaps in communication skills training for diabetes care were identified in this systematic review: training needs to understand what health professionals and patients’ thoughts and goals should be based on encouraging patients to self-manage and shared understanding of diabetes management [ 23 ].…”

“…Attempts to cover this breadth within a training curriculum risks a superficial approach to a complex phenomenon, where knowing ‘where to start’ may be difficult. Our systematic review suggested that such that ‘one size fits all’ approaches to communication skills training should be exercised with caution [ 23 ]. Furthermore, the training of communication skills for Chinese GPs may represent a paradigm shift in learning and patient care, which could be overwhelming for many learners, risking disinterest or disengagement.…”

Síntesis de evidencia y recomendaciones: directrices para el tratamiento farmacológico de la hipertensión arterial en adultos

“…En el Cuadro 4 se presentan algunas barreras, facilitadores y estrategias de implementación que pueden ser consideradas por los países. (16,20,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) CUADRO 4. Barreras, facilitadores y estrategias para mejorar el cumplimiento de las recomendaciones…”