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Work together to achieve wellness goals of people living with diabetes
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In this issue, Susan Weiner, MS, RDN, CDE, CDN, FAADE, talks with clinical psychologist and diabetes educator Nicole M. Bereolos, PhD, MPH, MSCP, CDE, about how health care providers can better engage people with diabetes to help them devise and reach goals for living well with their condition.
Why is the topic of communication between the health care team and people with diabetes particularly relevant now?
Bereolos: As you probably have noticed, many people living with chronic conditions are becoming more engaged and better informed. They are coming into appointments asking about just-approved devices and drugs and even about off-label uses of medications. Patient advocates are getting involved from the ground up in the process of taking medications and devices from development through FDA approval. At each stage, companies are asking for people living with diabetes to provide input on what they need and expect from the product. Potential users are testing out devices in the early stages and are at the table as the product continues to be refined and eventually submitted for approval. These individuals are asking for the clinical trial data and giving a critical review, which in the past has been reserved for health care professionals with advanced degrees. The role of individuals living with diabetes has evolved, and their expectations of their health care team involvement has changed as well.
What are some common errors that health care professionals make that may cause offense when communicating with people with diabetes?
Bereolos: People with diabetes are simply requesting that they be viewed as a person, not a disease. Some terms and treatment styles prioritize the disease. Here are some examples.
It is likely that someone will put forward their best effort and still not perfect their glycemic control. In that case, the terms “noncompliant” and “nonadherent” are perceived as very stigmatizing. Also, discussion about lab values failing to reach a certain goal can make a person feel defeated. Visits with health care professionals become a punishment rather than a time to problem-solve the best strategies to manage a lifelong condition.
When someone with type 2 diabetes is advised to start insulin, they often have a sense of failure and feel that they did something to deserve the punishment, which is insulin. Instead, the person may not be informed that type 2 diabetes is a progressive condition that often eventually requires insulin.
Providing an “eat this, not that” list is often intended as a guide; however, someone with diabetes may take that list very literally and not learn how to incorporate all foods in moderation. Eventually, this approach of providing a handout with limited options leads to a sense of deprivation and guilt if the person deviates from the list.
What suggestions do you have for health care providers to improve their communication with people living with diabetes?
Bereolos: People often feel rushed through their encounters with health care providers. In addition, much of the encounter centers on concepts and jargon that can feel irrelevant to the person sitting in the office. Although the theoretical concepts of the disease state may be important for the health care provider in the development of a treatment plan, this is not what the person living with the condition necessarily wants to hear.
Many people with diabetes prefer a more collaborative model in which they play a role in decision-making. It is much more effective when the person living with diabetes is involved in prioritizing goals and taking ownership of their health. Success is much more likely when the individual perceives a need for change, has the internal motivation to follow through and believes in their own ability rather than when behavior change is the physician’s idea. Using this more person-centered approach allows an individual to understand that some factors are within their control and that the disease state is not in charge.
On another level, providers should express empathy. You may not know what it is like to live with diabetes or to have the same barriers as the person sitting in front of you, but it is important to show an understanding of that viewpoint. Considering a person’s unique psychosocial situation can help with treatment decisions. For example, an adult living with type 2 diabetes who is now caring for a parent with vascular dementia may need a very simple treatment regimen to prioritize their own health. It can take thorough interviewing and a good rapport to gather this type of information.
Also, being aware of your body language and a power/privilege differential is important to being an effective health care provider. Eye contact, vocal tone and word choice are all components of communication and each equally important.
The ultimate goal in working with people who live with diabetes is to empower them to thrive with diabetes. We must realize that perfection is not the endpoint, but that living well is the goal.
For more information:
Nicole M. Bereolos, PhD, MPH, MSCP, CDE, is a licensed clinical psychologist in private practice in Dallas. She specializes in behavioral medicine. Reach her at nbereolos@gmail.com.
Susan Weiner, MS, RDN, CDE, CDN, FAADE, is the 2015 AADE Diabetes Educator of the Year and author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com.
Disclosures: Bereolos reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.