Look Who's (Not) Talking: Diabetic patients' willingness to discuss self-care with physicians

• Autores: Elizabeth A Beverly, Om P Ganda, Yishan Lee, Kelly M Brooks, Nina F. Lewis-Schroeder, Masakazu Hirose, Katie Weinger
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 35, Nº. 7, 2012, págs. 1466-1472
• Idioma: inglés
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  • Nearly one-half of diabetic patients have glycated hemoglobin A^sub 1c^ (HbA^sub 1c^) levels above recommended targets. Effective physician-patient communication improves glycemia and diabetes self-care; however, communication gaps may exist that prevent patients from discussing self-care problems with treatment providers. We assessed diabetic patients' (n = 316, 85% white, 51% female, 71% type 2 diabetes, 59 ± 11 years old, 16 ± 3 years education, 19 ± 13 years diabetes duration, and HbA^sub 1c^ = 7.9 ± 1 .4%) HbA^sub 1c^, frequency of self-care, diabetes-related distress, depressive and anxiety symptoms, coping styles, diabetes quality of life, and self-care communication in the treatment relationship. Multivariate logistic regression models examined the main and interaction effects of health and psychosocial factors associated with patients' reluctance to discuss self-care. Patients reported positive relationships with their doctors and valued honest communication; however, 30% of patients were reluctant to discuss self-care. Reluctant patients reported less frequent self-care (P = 0.05), lower diabetes quality of life (P = 0.002), and more diabetes-related distress (P = 0.001), depressive symptoms (P < 0.001), and anxiety symptoms (P = 0.001). Patients who reported elevated depressive symptoms, although not necessarily major depression, were more likely to be reluctant to discuss self-care (odds ratio [OR] 1.66 for 10-point change in t score; P < 0.001), whereas patients who were older (OR 0.78 for 10-year change; P = 0.05) and those who used more self-controlled coping styles (OR 0.78 for 10-point change; P = 0.007) were less likely to be reluctant. Awareness of elevated depressive symptoms is important in clinical practice given that these patients may be more reluctant to discuss self-care. Interventions and evidence-based approaches are needed to improve both depressive symptoms and physician-patient communication about self-care.