Diabetes is an excellent chronic disease model for studying provider-patient communication and complex decision-making in older persons, because patient preferences, clinical judgment, and incomplete scientific evidence should be incorporated into the discussion. While approximately 40 percent of the patients with diabetes in the United States are 65 years or older, limited evidence exists to guide their management. In younger populations, tight glycemic control has been demonstrated to prevent microvascular complications such as retinopathy and nephropathy. However, older patients may die of other causes before developing diabetic complications. Given that the treatment of diabetes can adversely affect quality of life through dietary restrictions, the burden of taking medications, hypoglycemia, and the discomfort of insulin injections, treatment should have more benefit than harm. Therefore, it is crucial to understand patient preferences regarding the aggressiveness of treatment. The ultimate goal of this research program is to improve doctor- patient communication about the issues relevant to diabetes care of older persons through provider and patient educational tools that can be used in routine daily clinical practice.
The specific aims i n this study of 600 patients with diabetes aged 65 years or older are: 1) to assess older patients' preferences regarding the aggressiveness of their diabetes treatment; 2) to identify the factors associated with the aggressiveness of patients' preferences for diabetes care; and 3) to determine the concordance between older patients' preferences and physicians' preferences regarding the aggressiveness of diabetes care, as well as with actual treatment style. Quantitative interviews will measure patient utilities for diabetic complications and intensity of therapy through the time trade-off technique. The interview will also use validated scales to measure the patient's view of different domains of the Health Belief Model including: 1) vulnerability to the ill effects of diabetes; 2) severity of diabetes as a disease and illness; 3) benefits of treatment; and 4) barriers to treatment. Physicians will be surveyed about their preference for individual patient's aggressiveness of therapy, and the actual treatment style will be obtained from the medical record. These data sources will supply a comprehensive view of the factors influencing a patient's preferences for aggressiveness of diabetes treatment, and enable the patient's choices to be compared with those of physicians and actual medical practice.
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| Huang, Elbert S; Sachs, Greg A; Chin, Marshall H (2006) Implications of new geriatric diabetes care guidelines for the assessment of quality of care in older patients. Med Care 44:373-7 |
