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Cited by 717Patient-Provider Communication in HealthcareDiabetes Management and EducationMedication Adherence and Compliance

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

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Heisler, Michele, Bouknight, Reynard R., Hayward, Rodney A., Smith, Dylan M., Kerr, Eve A.·2002·Journal of General Internal Medicine
DOI 10.1046/j.1525-1497.2002.10905.xPMC PMC1495033
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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]; alpha = 0.96), rating of providers' communication with a 5-item scale (Provider Communication [PCOM]; alpha = 0.93), understanding of diabetes self-care with an 8-item scale (alpha = 0.90), and patients' completion of diabetes self-care activities (self-management) in 5 domains (alpha = 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 beta: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized beta: 0.10; P =.004). Understanding was strongly and independently associated with self-management (standardized beta: 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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  • An engaging and open dialogue between HCPs and people with T1D is highly important for optimal disease management, as it promotes collaboration, communication, and people's participation in their own treatment decisions.

    “Previous studies have identified that an engaging and open dialogue between HCPs and people with T1D is highly important for optimal disease management, as it promotes collaboration, communication, and people's participation in their own treatment decisions.25,26”

    From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [25]

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Authors
Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A.
Affiliations
  • University of Michigan (US)
  • Michigan State University (US)
  • VA Ann Arbor Healthcare System (US)
Corresponding author
Heisler, Michele
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2002-04
Volume
17
Issue
4
Pages
243-252
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1046/j.1525-1497.2002.10905.x
PMC
PMC1495033
OpenAlex
W2086797813
Cited by
717
References
72
Citations by year
2026: 16 · 2025: 16 · 2024: 10 · 2023: 18 · 2022: 21 · 2021: 36 · 2020: 41 · 2019: 36 · 2018: 39 · 2017: 45 · 2016: 34 · 2015: 29 · 2014: 53 · 2013: 37 · 2012: 54
FWCI
41.77
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Health Services Research and Development
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords
diabetes self-management, patient-physician communication, participatory decision-making, shared decision-making, diabetes self-care, patient-provider interaction, veterans, diabetes management
MeSH terms
Aged, Communication, Decision Making, Diabetes Mellitus, Female, Hospitals, Veterans, Humans, Male, Middle Aged, Patient Participation, Physician-Patient Relations, Surveys and Questionnaires, Sampling Studies, Self Care, Multivariate Analysis, Linear Models, Treatment Outcome, Patient Satisfaction, Outcome Assessment, Health Care, Health Care Surveys

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