Abstract
Background
Shared decision-making (SDM) is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM.
Methods
In a web-based survey, 150 Australians aged 18–35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM.
Results
Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for “My clinician enquires about how I manage my diabetes”; 93.4% to 82.2% for “My clinician listens to my opinion about my diabetes management”; 89.9% to 74.1% for “My clinician is supportive of my diabetes management”; 93.2% to 66.1% for “My clinician suggests ways in which I can improve my self-management”; 96.6% to 85.7% for “The advice of my clinician can be understood”; 98.9% to 82.2% for “The advice of my clinician can be trusted”; and 86.5% to 67.9% for “The advice of my clinician is consistent with other members of the diabetes team”. Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of agreement to SDM for all consultations was 84.3%. Focus group participants reported actively seeking clinicians who practiced SDM. A lack of SDM was frequently cited as a reason for discontinuing consultation. The dominant three themes in focus group discussions were whether clinicians acknowledged patients’ expertise, encouraged patients’ autonomy, and provided advice that patients could utilize to improve self-management.
Conclusion
The majority of clinicians engaged in SDM. Young adults with type 1 diabetes prefer such clinicians. They may fail to take up recommended health services when clinicians do not practice this component of patient-centered care. Such findings have implications for patient safety, improved health outcomes, and enhanced health service delivery.
Acknowledgments
This research was conducted under the auspices of a program of research funded by the National Health and Medical Research Council (NHMRC) of Australia: NHMRC Program Grant 568612. The failure of the majority of Australian adults to reach clinically dictated treatment target levels of Type 1 diabetes control is a case study in the program. We thank the young adults that were involved in the focus groups and/or the survey for their contribution to this research. We acknowledge Janet Long’s contribution to data analysis and discussion and the editorial contribution of Dr Wendy Lipworth, Professor Don Chisholm AO, and Professor Lesley Campbell AM. A version of this paper was presented at the International Society for Quality in Health Care, 29th International Conference. Geneva, Switzerland. 21–24 October 2012.
Author contributions
JW researched data, contributed to the conception, design and discussion of the research, wrote, reviewed, and edited the manuscript. MW researched data, contributed to discussion, reviewed and edited the manuscript. JG, RD, and JB contributed to the conception design and discussion of the research, and reviewed and edited the manuscript. All authors guarantee this work and are accountable for all aspects of this work.
Disclosure
The authors declare that they have no competing interests in this work.