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Theme: CLAHRC - Person-Centred Care
Diabetes is a chronic condition associated with many long-term complications. It affects a large number of people and its management is costly to the NHS. People with diabetes need to be actively involved in managing their condition, which can often be a complex business. They receive advice in regular, but typically infrequent, consultations with health care professionals. However, they do not always discuss things which concern them in these consultations, perhaps because of perceived limited time or embarrassment.
We tested a ‘pre-consultation’ intervention in the half hour prior to a hospital clinic appointment with a Consultant Diabetologist. This involved seeing a Health Care Assistant (HCA) who supported the patient in completing an electronic questionnaire aimed at helping them to identify important areas for discussion (their ‘agenda’) in the consultation with their Diabetologist. We anticipate that this may enable the patient to play a more active role in that consultation and subsequently make them more confident (and hence more successful) in managing their condition. This would have required a large trial involving many centres, but in order to plan for a successful trial we conducted a ‘pilot study’, essentially a scaled-down version of what the full trial might look like.
This research is funded by a National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) grant.
Our pilot aimed to provide the necessary information for the planning of a full scale trial:
Specific areas addressed in this pilot were to:
We randomly allocated 71 suitable willing patients to receive the intervention (38 patients) or not (33 patients) when they attended a hospital out-patient appointment. We asked them to complete some standard questionnaires and provide blood samples (at baseline, 3 months and 6 months), and agree to recordings of consultations (26 patients) and undergo interviews (12 patients).
Preliminary findings suggested that the completion of an agenda form had a ‘magnifier’ effect upon existing doctor-patient relationships. Where both doctors and patients were comfortable with the existing nature of communication (be it doctor- led, patient-led or shared) the agenda form appeared to act as a prompt for discussions during the consultation. However, where existing tensions were evident within the doctor-patient relationship (e.g. where the doctor and patient were not in agreement about their preferred style of consultation) the agenda form appeared to amplify those tensions.
While the analysis of data is ongoing, the pilot study has demonstrated the utility of having clinician staff (from HCAs to Consultants), research network (PenCTU and Clinical Research Networks), academics and patient and public involvement (PPI representatives) involved in designing and evaluating an intervention study - and the value of conducting a small scale pilot study prior to undertaking a full randomised controlled trial of a complex intervention.
As well as producing clinically relevant findings from the study, we also intend to produce a ‘lessons learned’ toolkit for use by commissioners, service providers and patient partners preparing to undertake similar research.
If you are interested in finding out more about this study, please contact:
Dr Julia Frost
Research Fellow (Third Gap)
Institute of Health Services Research
University of Exeter Medical School
Salmon Pool Lane
Dr Andy Gibson, Dr Bijay Vaidya, Dr Mark Daly, Catherine Argyle, Wendy Ingram, Prof. Jonathan Pinkney, Jane Vickery, James Harris, Faith Harris-Golesworthy