Abstract
BackgroundDiabetes care has been traditionally focused on targeting certain levels of glycemic control. This narrow emphasis may impose burdens on patients, including high treatment costs, illness-related work, or side effects from medications, while leaving other patient needs and goals under-addressed. The authors aim to shift the paradigm of care for people with diabetes, to focus on quality of life, burden of treatment, safety, and avoidance of future events: the QBSAfe domains.MethodsWe describe a single-arm pilot study to assess the feasibility and acceptability of using the QBSAfe agenda setting kit (ASK) during routine clinical visits. The set of 14 conversation aid cards was co-developed with patients, family caregivers, and clinicians. The ASK will be used in the context of a clinic visit, which will be recorded by members of the study team to identify patterns of clinician-patient conversations. Feasibility will be measured by the number of participants recruited, time to goal accrual, and completeness of data collection; acceptability will be assessed using post-visit surveys of patients and clinicians. A subgroup of patients will be invited to participate in post-visit qualitative semi-structured interviews for additional feedback. This study will be conducted across three medical centers in the Midwest and East Coast of the USA.DiscussionCurrent healthcare infrastructure and associated demands and pressures on clinicians make changes in care difficult. However, this intervention has the potential to shift conversations during clinical encounters so they can address and directly respond to patient needs, symptoms, and capacity. As part of the QBSAfe ASK, the authors are also actively collaborating with a variety of stakeholders to create tools to help clinicians respond more effectively to patient concerns as they are raised during the clinical encounters. Additional insights about the use of the QBSAfe approach in the virtual space will be gathered during the process of our study due to restrictions imposed upon face to face visit during the COVID-19 pandemic.Trial registrationClinicalTrials.gov, NCT04514523. Registered 17 August 2020—retrospectively registered.
Highlights
Diabetes care has been traditionally focused on targeting certain levels of glycemic control
In an effort to shift the paradigm of care for people with diabetes to a more patient goal-centric approach, we developed and propose to test the Quality of life (QBSAfe) agenda setting kit (ASK)
Older patients are especially vulnerable to the added burdens of diabetes care, as they often already have multiple other comorbidities, symptom burden, and/or functional impairments impacting quality of life [22, 23]
Summary
Diabetes care has been traditionally focused on targeting certain levels of glycemic control. This narrow emphasis may impose burdens on patients, including high treatment costs, illness-related work, or side effects from medications, while leaving other patient needs and goals under-addressed. The authors aim to shift the paradigm of care for people with diabetes, to focus on quality of life, burden of treatment, safety, and avoidance of future events: the QBSAfe domains. Multiple chronic conditions and impairments may create barriers to self-management of complex tasks (such as insulin administration and dosing) and may leave patients overwhelmed and overburdened by the work required to manage their conditions. Social isolation, limited social support, poor financial, physical and mental health, and personal and social complexities limit the capacity of patients and caregivers to shoulder the mushrooming treatment workload [5]
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