867-P: Variation in the Setting of Type 2 Diabetes Diagnosis Disclosure

Abstract

The disclosure of a new type 2 diabetes (T2D) diagnosis shapes patients’ T2D-related experiences, with more supportive approaches linked with better self-care and lower diabetes distress. Given changes in patient-provider communication and greater use of telemedicine, we examined the setting of T2D disclosures among adults in a large, integrated healthcare delivery system. Physicians reviewed charts of a random sample of 200 adults diagnosed with T2D between 2014-2018 to determine the diagnosis disclosure setting. Identified settings were an in-person visit, telemedicine visit (telephone/video), secure message via the online patient portal, mailed letter, or voicemail. These settings were further categorized into 2-way synchronous communication (in-person/telemedicine), 2-way asynchronous communication (secure message), and 1-way asynchronous communication (letter/voicemail). We examined differences in disclosure setting by patient demographics. The disclosure setting was discernible for 197/200 individuals; 55.3% received the diagnosis via 2-way synchronous communication (25.4% in-person, 29.9% telemedicine), 23.9% via 2-way asynchronous communication, and 20.8% via 1-way asynchronous communication (18.8% letter, 2% voicemail). Disclosure setting did not differ by age, gender, or level of neighborhood deprivation. Latinx individuals were overrepresented among those receiving the diagnosis via 1-way asynchronous communication (42.5% vs. 17.1% 2-way synchronous vs. 8.7% 2-way asynchronous, p=0.001) and had lower online patient portal enrollment (59%). The heterogeneity in T2D diagnosis disclosure setting suggests a lack of standard practices for communicating a T2D diagnosis. The common use of asynchronous modalities is concerning given the gravity of the diagnosis, especially when established best practices for communicating bad news to patients exist. Disclosure K. Gu: None. C. Gong: None. M. A. Blatchins: None. P. Mishra: None. R. W. Grant: None. A. Gopalan: None. Funding Kaiser Permanente Northern California