Conceptual framework and responding approach of treatment burden of type 2 diabetes mellitus: A video recording-based qualitative analysis

Abstract

BackgroundPatients with type 2 diabetes mellitus (T2DM) frequently face a considerable treatment burden. Research on the specific treatment burden associated with T2DM is still in its early stages both in China and worldwide. ObjectiveBased on video recordings of clinical diagnostic and therapeutic scenarios, this study aims to summarize the conceptual framework of treatment burden related to T2DM among patients in China Mainland and explore proactive coping strategies of general practitioners (GPs). MethodsThe researchers conducted a retrospective qualitative analysis using video records that filmed during 2018-2019 from general practice training clinics of a standardized training base in Guangdong Province of China. This analysis was integrated with the existing conceptual framework of treatment burden, employing qualitative research methods such as observational record forms, field notes, coding extraction and thematic analysis. ResultsFrom 25 video records, 49 instances of doctor-patient communication related to the treatment burden of T2DM were selected and analyzed. All six themes from the original conceptual framework were explored. Additionally, the researchers identified two additional thematic items (medical information burden and drug-induced hypoglycemia). The finding led to the development of a modified conceptual framework for the treatment burden of T2DM, encompassing seven observable dimensions: financial burden, medication burden, medical management burden, lifestyle change burden, healthcare system burden, time/travel burden, and medical information burden. Each sub-theme's definition was expanded accordingly. The consultation process analysis indicated that trained GPs can actively respond to treatment burdens (medication burden, medical information burden, time/travel burden, lifestyle change burden) using skills such as patient education, enhanced communication, shared decision-making and motivational interviewing. ConclusionThe study constructs a modified conceptual framework for the treatment burden of T2DM. By integrating the identification of conceptual dimensions in clinical diagnosis and treatment, it explores how Chinese GPs can use doctor-patient communication skills to proactively address specific treatment burdens of T2DM patients.