Goal SettingPatient-reported use of collaborative goal setting and glycemic control among patients with diabetes
Introduction
Despite the availability of effective pharmacological and other treatments, clinical control, measured by hemoglobin (Hb) A1c, is often not achieved among patients with diabetes [1], [2]. Recently, interest has centered on how the features of patient–clinician communication may affect health outcomes [3]. Of particular interest is the role of active patient participation during clinical encounters [4].
Previous observational [5], [6], [7], [8] and interventional studies [9] have highlighted the benefits of active patient participation in medical encounters, although findings in the context of diabetes care are mixed [10]. One key component of active patient participation is collaborative goal setting [11]. Collaboratively setting a goal has been shown to lead to increased levels of goal commitment [4], [12], [13], [14], [15], [16], [17]. Furthermore, collaboratively helping patients set and follow up on goals may be an effective way to help patients improve their self-efficacy, an important predecessor to effective self-management, and thus glycemic control and other patient-centered outcomes [11], [18]. Furthermore, the act of collaboratively setting goals may be beneficial to patient–clinician rapport, improving factors, such as patient trust, which have been shown to improve patient adherence to recommended treatment [19]. As such, the American Diabetes Association's clinical practice guidelines acknowledge the importance of collaborative goal setting in diabetes care management [20].
Among patients with diabetes, patients’ perceptions of collaborative care (including collaborative goal setting) have been shown to be associated with patients’ reported self-management [7] and, indirectly, with hypertension control [5]. However, the relationship between collaborative goal setting and clinical control among patients with diabetes remains poorly understood. Using a patient survey joined with laboratory data on HbA1c control among a sample of insured, primary care patients with diabetes, we describe patient-reported use of collaborative goal setting when receiving medical care for their diabetes, and evaluate the associations between patient reports of collaborative goal setting and subsequent glycemic control (as measured by HbA1c). As advocated by Street and colleagues [3], we do so by evaluating plausible pathways through which communication may contribute to healing. Specifically, we evaluate whether patient perceived self-management competence and physician trust mediate the relationship between patient-reported use of collaborative goal setting when receiving medical care for their diabetes and subsequent glycemic control.
Section snippets
Patient selection
Survey-eligible patients were selected from a previously established cohort of insured patients aged 18 years and over who initiated oral mono-therapy between 2000 and 2005 [21]. This cohort included all insured patients receiving diabetes care between 2000 and 2005 from a salaried, multi-specialty group practice in southeast Michigan. The medical group, which staffs 27 ambulatory clinics in Detroit and its surrounding suburbs, is owned by an integrated health system which maintains a large
Sample characteristics
Among the N = 1580 patients contacted for survey administration, N = 190 were ineligible (N = 17 were deceased, 5 did not speak English, 27 reported not having diabetes and 104 reported currently using insulin and N = 37 did not have valid contact information). One thousand and sixty-five (N = 1065) eligible respondents completed the survey (N = 951 via mail and N = 114 via telephone) resulting in an overall response rate of 77% (i.e., 1065/(1580 − 190)). Those who reported not seeing a primary care physician
Discussion
Findings here illustrate that, controlling for patient characteristics including the patient's prior HbA1c control, the more patients with diabetes report engaging in collaborative goal setting when receiving medical care for their diabetes, the more likely they are to report both increased trust in their physician and high perceived competence, which in turn are associated with better glycemic control. As such, these findings indicate that engaging patients with diabetes in collaborative goal
Funding
The database used was developed under a contract from Sanofi-Aventis.
Acknowledgments
J.E.L, E.D., and H.L.M. worked on the concept and design. J.E.L. and E.D. collected the data. J.E.L., H.L.M., and L.D. analyzed the data. J.E.L., H.L.M., E.D., M.H., R.W., and L.D. interpreted the data, reviewed/edited the manuscript, and gave final approval. The study was funded by Sanofi-Aventis. Representatives from the funding agency did not play any role in the study design, data collection, analyses or interpretation. The Institutional Review Board of the participating medical group
References (34)
- et al.
How does communication heal? Pathways linking clinician–patient communication to health outcomes
Patient Educ Couns
(2009) - et al.
Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention
Patient Educ Couns
(2005) - et al.
Mechanisms governing organizational performance in complex decision-making environments
Org Behav Hum Decis Process
(1990) - et al.
Differential Engagement of Self-Reactive Influences in Cognitive Motivation
Org Behav Hum Decis Process
(1986) - et al.
Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002
Ann Intern Med
(2006) - et al.
Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change
Diabetes Care
(2005) Analyzing communication in medical consultations: do behavioral measures correspond to patients’ perceptions?
Med Care
(1992)- et al.
Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication
Circulation
(2008) - et al.
Supporting autonomy to motivate patients with diabetes for glucose control
Diabetes Care
(1998) - et al.
The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management
J Gen Intern Med
(2002)
Change in metabolic control and functional status after hospitalization. Impact of patient activation invervention in diabetic patients
Diabetes Care
Provider-patient communication and metabolic control
Diabetes Care
Patient-centered goal setting as a tool to improve diabetes self-management
Diabetes Educ
Does physician communication influence older patients’ diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS)
J Gerontol Ser A Biol Sci Med Sci
The prevalence of comorbid depression in adults with diabetes: a meta-analysis
Diabetes Care
Assessment of diabetes-related distress
Diabetes Care
An ethical justification for the Chronic Care Model (CCM)
Health Expect
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