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The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management

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Abstract

OBJECTIVE: Patients’ self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients’ diabetes self-management. This study assessed the influence of patients’ evaluation of their physicians’ participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management.

DESIGN: We surveyed 2,000 patients receiving diabetes care across 25 Veterans’ Affairs facilities. We measured patients’ evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; α=0.96), rating of providers’ communication with a 5-item scale (Provider Communication [PCOM]; α=0.93), understanding of diabetes self-care with an 8-item scale (α=0.90), and patients’ completion of diabetes self-care activities (self-management) in 5 domains (α=0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding.

RESULTS: Sixty-six percent of the sample completed the surveys (N=1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P<.01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized β: 0.18; P<.001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized β: 0.10; P=.004). Understanding was strongly and independently associated with self-management (standardized β: 0.25; P<.001).

CONCLUSION: For these patients, ratings of providers’ communication effectiveness were more important than a participatory decision-making style in predicting diabetes self-management. Reported understanding of self-care behaviors was highly predictive of and attenuated the effect of both PDMstyle and PCOM on self-management, raising the possibility that both provider styles enhance self-management through increased patient understanding or self-confidence.

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Author information

Authors and Affiliations

  1. the Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Mich

    Michele Heisler MD, MPA, Rodney A. Hayward MD, Dylan M. Smith PhD & Eve A. Kerr MD, MPH

  2. The Robert Wood Johnson Clinical Scholars Program, University of Michigan School of Medicine, Ann Arbor, Mich

    Michele Heisler MD, MPA, Rodney A. Hayward MD & Eve A. Kerr MD, MPH

  3. Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Mich

    Rodney A. Hayward MD

  4. Michigan Diabetes Research and Training Center, University of Michigan School of Medicine, Ann Arbor, Mich

    Rodney A. Hayward MD

  5. the College of Human Medicine, Michigan State University, East Lansing, Mich

    Reynard R. Bouknight MD, PhD

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  1. Michele Heisler MD, MPA
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  2. Reynard R. Bouknight MD, PhD
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  3. Rodney A. Hayward MD
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  4. Dylan M. Smith PhD
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  5. Eve A. Kerr MD, MPH
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Corresponding author

Correspondence to Michele Heisler MD, MPA.

Additional information

This work was supported by The Department of Veterans Affairs Office of Quality and Performance, the VA Health Services Research and Development Program (Grant DIS-99221-1), and The Robert Wood Johnson Foundation. Dr. Kerr is a VA HSR&D Career Development Awardee.

The views expressed herein do not necessarily represent those of The Robert Wood Johnson Foundation or The Department of Veterans Affairs.

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Heisler, M., Bouknight, R.R., Hayward, R.A. et al. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J GEN INTERN MED 17, 243–252 (2002). https://doi.org/10.1046/j.1525-1497.2002.10905.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.10905.x

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