As per Clark et al, self-management or self-care in the context of chronic diseases refers to a set of skilled behaviors to manage one's illness. These include: “1) engaging in activities that promote health, build physiologic reserve, and prevent adverse sequelae; 2) interacting with health care providers and adhering to recommended treatment protocols; 3) monitoring physical and emotional states and making appropriate management decisions on the basis of the results of self-monitoring; and 4) managing the effects of illness on the patient's ability to function in important roles and on emotions, self-esteem, and relationships with others.”20 This study focuses on the first two of these skilled behaviors.
The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self-management
Article first published online: 30 APR 2002
Journal of General Internal Medicine
Volume 17, Issue 4, pages 243–252, April 2002
How to Cite
Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M. and Kerr, E. A. (2002), The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self-management. Journal of General Internal Medicine, 17: 243–252. doi: 10.1046/j.1525-1497.2002.10905.x
- Issue published online: 30 APR 2002
- Article first published online: 30 APR 2002
- physician-patient relations;
- disease management;
- ambulatory care;
- chronic disease
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.