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Coyne I, Sleath B, Surdey J, Pembroke S, Hilliard C, Chechalk K, Rafferty S, Rogerson S, Hughes M M, Murphy M, Cody D, Roche E. Intervention to promote adolescents' communication and engagement in diabetes clinic encounters: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 126:108322. [PMID: 38772095 DOI: 10.1016/j.pec.2024.108322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
AIM To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. METHODS Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. RESULTS Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. CONCLUSIONS Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. PRACTICE IMPLICATIONS Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required.
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Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland.
| | - B Sleath
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - J Surdey
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Pembroke
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - C Hilliard
- Children's Health Ireland, Dublin 8, Ireland
| | - K Chechalk
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - S Rafferty
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Rogerson
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Hughes M
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Murphy
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - D Cody
- Children's Health Ireland, Department of Diabetes and Endocrinology, Crumlin, Dublin 12, Ireland
| | - E Roche
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland; Children's Health Ireland, Department of Endocrinology and Diabetes, Tallaght, Dublin 24, Ireland
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2
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How a diagnosis of polycystic ovarian syndrome (PCOS) is communicated impacts well-being. BJGP Open 2022; 6:BJGPO.2022.0014. [PMID: 35487582 DOI: 10.3399/bjgpo.2022.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Polycystic Ovary Syndrome (PCOS) is associated with well-being. Many women report dissatisfaction with the diagnostic process. AIM This study assessed the impact of aspects of the diagnostic consultation on subsequent well-being. DESIGN & SETTING A retrospective community survey. METHOD Females with PCOS (n=146) completed measures of aspects of the diagnostic consultation (consultation satisfaction, language used in terms of framing and focus) and current well-being (body esteem, quality of life). RESULTS Most diagnoses took place in Primary Care. The majority showed a medium degree of satisfaction with the consultation. Most diagnoses were framed using a neutral term 'raised' but many used the more judgemental term 'abnormal'. The majority focused on taking oral contraception and weight management. Poorer body esteem (body dissatisfaction and dieting behaviour) and poorer quality of life (self-identity, concerns about fertility, physical health, hirsutism and overall quality of life) were predicted by lower communication comfort during the diagnostic consultation and greater use of the word 'raised'. Greater use of the word 'irregular' predicted greater concerns about fertility, greater focus on fertility predicted greater concerns about physical health and greater focus on appearance predicted greater concerns about hirsutism. CONCLUSION How a diagnosis of PCOS is delivered can impact subsequent well-being. The diagnostic consultation may take a few minutes, yet how these minutes are managed, what words are used, and how this makes the patient feel may change how the patient makes sense of their condition and influence the impact of the condition on their well-being for the longer term.
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3
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Tremblay ES, Ruiz J, Dykeman B, Maldonado M, Garvey K. Hispanic Caregivers' experience of pediatric type 1 diabetes: A qualitative study. Pediatr Diabetes 2021; 22:1040-1050. [PMID: 34232537 PMCID: PMC8530860 DOI: 10.1111/pedi.13247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/30/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE It is widely recognized that Type 1 Diabetes (T1D) outcomes are worse among Hispanic children; however, little is published about the perspectives of these patients and their caregivers. Our intent was to characterize the lived experience of Hispanic caregivers of children with T1D, focusing on the role of language and culture and their perspectives on current medical care and alternative care models. We studied Hispanic caregivers of patients (age 2-17 years) with T1D of greater than 6 months' duration. RESEARCH DESIGN AND METHODS We completed semi-structured interviews and focus-groups of a purposive sample of 20 members of our population of interest. We developed a codebook and completed multidisciplinary consensus coding, then conducted iterative thematic analysis using qualitative software and discussion to generate themes. RESULTS We gathered data from 20 Hispanic caregivers of T1D patients (11.37 ± 3.00 years old, 4.80 ± 2.84 years since diagnosis). 85% of caregivers were female, 80% preferred Spanish, and 15% were college-educated. Our analysis yielded 4 themes across the participants: (1) Culturally-based nutrition challenges, (2) Social isolation and lack of support for T1D care, (3) Hesitancy to fully embrace diabetes technology, and (4) Deferential views of care experience and providers. Overarching all of these themes was support for Hispanic group-based models of care tailored to address these concerns. CONCLUSIONS The unique concerns among Hispanic caregivers of children with T1D suggest the importance of culturally tailored interventions to improve care. With successful implementation, such interventions could diminish widening disparities in healthcare outcomes.
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Affiliation(s)
- Elise Schlissel Tremblay
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Jessica Ruiz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Blair Dykeman
- Boston Children’s Hospital, Institutional Centers for Clinical and Translational Research
| | - Michele Maldonado
- Boston Children’s Hospital, Children’s Hospital Primary Care Center, Social Work
| | - Katharine Garvey
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
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4
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Chalew S, Delamater AM, Washington S, Bhat J, Franz D, Gomez R, Felipe D, Tieh P, Finger L. Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes? J Diabetes Sci Technol 2021; 15:1069-1075. [PMID: 34137288 PMCID: PMC8442203 DOI: 10.1177/19322968211021386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
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Affiliation(s)
- Stuart Chalew
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
- Stuart Chalew, MD, Department of
Pediatrics, Endocrinology and Diabetes, School of Medicine, Louisiana
State University Health Sciences Center, Children’s Hospital of New
Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.
| | - Alan M. Delamater
- Department of Pediatrics,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonja Washington
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Jayalakshmi Bhat
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Diane Franz
- Department of Psychology, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Dania Felipe
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Peter Tieh
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Laurie Finger
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
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5
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Baechle C, Stahl-Pehe A, Castillo K, Selinski S, Holl RW, Rosenbauer J. Association of family structure with type 1 diabetes management and outcomes in adolescents: A population-based cross-sectional survey. Pediatr Diabetes 2021; 22:482-494. [PMID: 33259124 DOI: 10.1111/pedi.13166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetes therapies have enormously changed during past decades, but only few studies have analyzed the association between family structure and diabetes management and outcomes. OBJECTIVE To analyze cross-sectionally the associations of family structure with type 1 diabetes (T1D) management and various diabetes outcomes. METHODS A total of 1635 11- to 17-year-old participants and their parents completed one of three baseline surveys as part of a nationwide, population-based cohort study on early-onset, long-standing T1D. Associations between family structure and outcome variables were analyzed by multivariable linear/logistic regression. RESULTS Compared to adolescents living with both parents (reference), HbA1c was 0.48% (95% confidence interval 0.24; 0.71) / 5.2 (2.6; 7.8) mmol/mol higher in adolescents living with one parent and 0.34% (0.08; 0.59) / 3.7 (0.9; 6.5) mmol/mol higher in those living with one parent and her/his partner. The blood glucose self-monitoring (SMBG) frequency was lower (single parent: -0.6 (-1.1; -0.2), parent and partner:-0.5 (-1.0; 0.0)) and parents reported more long-term consequences related to school or work (ORsingle-parent 1.52 (0.90; 2.57), ORparent + partner 1.50 (0.86; 2.60)). While living with one parent was associated with increased odds of insulin injection vs. insulin pump therapy (OR 1.61 [1.13; 2.29]), the odds of low hypoglycemia awareness (OR 1.75 [1.00; 3.08]) and diabetes complications (1.32 [0.78; 2.22]) were higher in people living with a parent and her/his partner. CONCLUSIONS Living with only one parent with or without a new partner was associated with less SMBG and pump use and poor diabetes outcomes. Future studies to explore the underlying mechanisms are required.
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Affiliation(s)
- Christina Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Katty Castillo
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Silvia Selinski
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
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Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
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7
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Goethals ER, Jaser SS, Verhaak C, Prikken S, Casteels K, Luyckx K, Delamater AM. Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2020; 163:108153. [PMID: 32325107 PMCID: PMC8008789 DOI: 10.1016/j.diabres.2020.108153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
AIMS Although research exists on parental communication in adolescents with type 1 diabetes (T1D), the role of communication by health care providers remains understudied. Grounded in Self-Determination Theory, this study examined the role of autonomy-supportive communication (i.e., providing meaningful rationale and offering choices with regard to treatment recommendations) by providers and parents, and how they interact in the prediction of diabetes outcomes. METHODS In this cross-sectional study, 135 adolescents (mean age 14.3 ± 2.1SD years), 171 mothers, and 121 fathers reported on autonomy-supportive communication from health care providers and parents, and on adolescent treatment adherence. HbA1c values were retrieved from the medical record. RESULTS In adolescent reports, perceived autonomy-supportive communication from providers but not from parents was positively related to treatment adherence. A significant interaction between autonomy-supportive communication from providers and parents pointed to the highest level of treatment adherence when adolescents perceived both providers and parents as autonomy-supportive. In contrast, parental reports revealed that parental autonomy-supportive communication was positively related to treatment adherence, whereas autonomy-supportive communication by providers was not. CONCLUSIONS Autonomy-supportive communication by providers and parents is associated with better treatment adherence in adolescents with T1D. Interventions to improve autonomy-supportive communication by parents and providers may improve treatment adherence of adolescents (e.g., communication training).
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Affiliation(s)
- Eveline R Goethals
- KU Leuven, Leuven, Belgium; Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chris Verhaak
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Sofie Prikken
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium
| | | | - Koen Luyckx
- KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, USA
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8
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Hilliard ME, Eshtehardi SS, Minard CG, Wheat S, Gunn S, Sanders C, Klenk R, Anderson BJ. Featured Article: Strengths-Based, Clinic-Integrated Nonrandomized Pilot Intervention to Promote Type 1 Diabetes Adherence and Well-Being. J Pediatr Psychol 2020; 44:5-15. [PMID: 29982765 DOI: 10.1093/jpepsy/jsy051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/11/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Given persistent challenges achieving optimal diabetes outcomes in adolescence, new interventions to support disease self-management and emotional well-being are needed. Approaches that emphasize adolescents' positive behaviors and attitudes ("strengths") are designed to incorporate positive provider communications into clinical encounters to encourage youths' engagement in adherence behaviors and enhance well-being. Methods This pilot study tested the feasibility, acceptability, and preliminary outcomes of a brief, strengths-based behavioral intervention for adolescents with type 1 diabetes. Adolescents (age 12-17 years) and parents were recruited, consented, and completed baseline and postintervention questionnaires. There was no randomization to a control group, and all participants received the pilot intervention. At the start of two clinic visits, diabetes care providers followed a semi-structured script to reinforce adolescents' diabetes-related strengths and adherence behaviors. Results Of 116 eligible families, 84 consented and 64 completed baseline (M age = 15.0 ± 1.8 years, 56% female, 69% White, M HbA1c = 8.6 ± 1.6%). Providers reported the intervention usually (95%) took <10 min to deliver. Participants and providers enjoyed the intervention and would like to see it as part of routine clinical care. Pre-post data indicated significant improvements in youth-rated diabetes strengths, adherence, burden, and relationship with provider, parent-reported diabetes burden, and provider-rated relationship with family (p < .05). Objectively measured adherence and glycemic control did not change. Conclusions This brief strengths-based, clinic-integrated intervention was feasible to conduct and stakeholders were satisfied. This intervention holds promise to have a positive impact on adolescents' diabetes adherence, well-being, and provider relationships. Lessons were learned to improve implementation and participant experience for a larger study.
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Affiliation(s)
| | | | | | - Suzanne Wheat
- Baylor College of Medicine and Texas Children's Hospital
| | - Sheila Gunn
- Baylor College of Medicine and Texas Children's Hospital
| | | | - Robyn Klenk
- Baylor College of Medicine and Texas Children's Hospital
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9
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Haas J, Persson M, Hagström Toft E, Rathsman B, Brorsson A, Lindholm Olinder A. Treatment satisfaction correlated with glycaemic control and burden of diabetes in Swedish adolescents with type 1 diabetes. Acta Paediatr 2020; 109:573-580. [PMID: 31469927 DOI: 10.1111/apa.14991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
AIM To assess treatment satisfaction and perceived discomfort or pain from the treatment, and potential associations with glycaemic control, type of treatment, perceived burden of diabetes, sex and age, in adolescents with type 1 diabetes. METHODS A cross-sectional study was performed at one paediatric and at one adult diabetes clinic in Sweden, preceded by a translation of 'Diabetes Treatment Satisfaction Questionnaire (DTSQ) Teen'. Adolescents with type 1 diabetes (15-20 years) participated. The questionnaires 'DTSQ Teen' and 'Check your health' were used. Data on glycosylated haemoglobin (HbA1c), type of treatment, sex and age were collected. RESULTS One hundred and thirty-eight adolescents (70 females, mean age 17.3, mean HbA1c 64.0 mmol/mol) participated. Treatment satisfaction correlated inversely with HbA1c (r = -.352, P < .001) and with all types of burden of diabetes (r = -.342 to -0.467, P < .001), but did not differ with type of treatment, sex and age. Perceived pain correlated inversely with burden on physical health (r = -.265, P = .002), mental health (r = -.237, P = .006) and quality of life (r = -.246, P = .004) but not with HbA1c, age or burden on social relations. Females perceived more discomfort or pain. CONCLUSION In Swedish adolescents with type 1 diabetes, treatment satisfaction correlated with both glycaemic control and perceived burden of diabetes.
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Affiliation(s)
- Josephine Haas
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs’ Children and Youth Hospital Stockholm Sweden
| | - Martina Persson
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs’ Children and Youth Hospital Stockholm Sweden
- Department of Medicine Clinical Epidemiological Unit Karolinska Institutet Stockholm Sweden
| | - Eva Hagström Toft
- Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm Sweden
- Diabetes Unit Ersta Hospital Stockholm Sweden
| | - Björn Rathsman
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs’ Children and Youth Hospital Stockholm Sweden
| | - Anna‐Lena Brorsson
- Sachs’ Children and Youth Hospital Stockholm Sweden
- Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education Karolinska Institutet Stockholm Sweden
- Sachs’ Children and Youth Hospital Stockholm Sweden
- Department of Medical Sciences Uppsala University Uppsala Sweden
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10
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Jolly M, Sethi B, O'Brien C, Sequeira W, Block JA, Toloza S, Bertoli A, Blazevic I, Vilá LM, Moldovan I, Torralba KD, Cicognani E, Mazzoni D, Hasni S, Goker B, Haznedaroglu S, Bourre-Tessier J, Navarra SV, Mok CC, Clarke A, Weisman M, Wallace D. Drivers of Satisfaction With Care for Patients With Lupus. ACR Open Rheumatol 2019; 1:649-656. [PMID: 31872187 PMCID: PMC6917325 DOI: 10.1002/acr2.11085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/22/2019] [Indexed: 01/02/2023] Open
Abstract
Objective Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE. Methods A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA‐SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors. Results The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC. Conclusion Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient's external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Ana Bertoli
- Instituto Reumatológico Strusberg, Cordoba, Argentina
| | | | - Luis M Vilá
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | | | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | | | | | - Ann Clarke
- University of Calgary, Calgary, Alberta, Canada
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