How Clinicians Report Discussing Self-Monitoring with Type 2 Diabetes Mellitus Patients

Wilkinson, Christina
Patient self-monitoring is critical to diabetes self-management. With no detailed approach to discussing self-monitoring by the American Diabetes Association we examined how clinicians report discussing self-monitoring with patients. Semi-structured interviews were conducted and three key questions followed from the research question. Analysis included transcripts and debriefing notes. A constant-comparison approach with category coding and thematic representation was used. How the clinicians discuss self-monitoring relates to their perceptions of: (1) the clinician-patient relationship, (2) needs beyond diabetes, and (3) perceived benefits of self-monitoring. Participants revealed a continuum of relational approaches from "partnership" with the goal to achieve patient independence on one end to benevolent paternalism wherein the clinician "keep[s] people safe", "make[s] slow fixes" and who, in a perfect world would like to "free" patients from insulin and self-monitoring requirements. Different needs of patients were reported to affect self-monitoring efforts and many benefits of self-monitoring were identified. While some clinicians take a partnering approach, others reported this possibility only in "the perfect world" due to patients' struggles and obstacles outside of the clinician's control. It's not clear how the approaches to discussing self-monitoring relate to the clinician-patient relationship, patients' needs or the benefits of self-monitoring. How clinicians talk about self-monitoring within the clinician-patient relationship may influence diabetes outcomes. Future research is needed to address the variety and severity of patients' needs and to include the patient perspective.
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