Evaluating clinician communication around glycemic management and its health impact for people with diabetes

PROJECT SUMMARY / ABSTRACT The objective of this project is to conduct a mixed methods study characterizing clinician communication around glycemic management (glycemic treatment and glycemic goals), identifying and quantifying the most effective communication practices. A large proportion of people with diabetes in the U.S. do not achieve glycemic goals, and suffer worse outcomes and likely more stigmatizing and judgmental language in clinical settings. While there is strong evidence that high quality clinician communication (defined as informative, compassionate, motivating and free of stigmatizing and judgmental language) improves diabetes outcomes, no studies to date have directly observed diabetes communication within clinical visits, and there are no validated tools for measuring the quality of this dialogue. Therefore, the specific communication practices that are most helpful (or harmful) for people with diabetes are not known, creating a major barrier to developing and implementing interventions that harness the power of clinical communication to improve diabetes care. Further, existing evidence-based communication interventions are high intensity and difficult to disseminate, creating a need for pragmatic interventions achievable within primary care practice. We hypothesize that changing clinician communication practices in simple, pragmatic ways is likely to improve diabetes self-management, which should in turn lead to improved glycemia and lower complications. In Aim 1, we will characterize clinician communication around glycemic management in 121 primary care visits for people with diabetes and HbA1c ≥8.0%. We will utilize data from the Black Box of Cultural Competence (Black Box) study, an observational cohort that audio-recorded routine primary care visits between people with diabetes and their primary care provider in the Veterans Affairs health system. We will use qualitative content analysis to identify features of good and poor communication quality, and use conversation analysis (a method of parsing the linguistic details of interactions) to evaluate the responses of people with diabetes, identifying the specific communication approaches and language that have the strongest positive and negative impact. In Aim 2, we will develop and psychometrically validate an instrument to quantitatively rate clinician communication quality around glycemic management, and determine its association with diabetes self-management abilities. These aims lead directly to our next steps: developing primary care interventions to improve diabetes outcomes. Identifying the most effective communication strategies will lead to efficient interventions that optimize clinicians’ language through targeted changes, and increase the ability of the healthcare team to support people with diabetes. Further, a validated instrument to measure the quality of glycemia management communication can serve as an important surrogate outcome for clinical interventions. Ultimately, we will leverage the power of clinical communication to improve outcomes for people with diabetes.