“I TAKE WHAT I THINK WORKS FOR ME”: A QUALITATIVE STUDY TO EXPLORE PATIENT PERCEPTION OF DIABETES TREATMENT BENEFITS AND RISKS

Kalpana M Nair; Mitchell AH Levine; Lynne H Lohfeld; Hertzel C Gerstein

Kalpana M Nair

Centre for Evaluation of Medicines, St. Joseph’s Healthcare Hamilton, Hamilton, Canada

Mitchell AH Levine

1 Centre for Evaluation of Medicines, St. Joseph’s Healthcare Hamilton, Hamilton, Canada; 2Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

Lynne H Lohfeld

Department of Medicine, McMaster University, Hamilton, Canada

Hertzel C Gerstein

Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada

Keywords

Qualitative research, patient perspective, diabetes, benefit & risk assessment

Abstract

Background

Diabetes is impacting more and more people each year. A key aspect of disease management is patient adherence to prescribed treatments. Treatment adherence is influenced by many factors, including the understanding of a treatment’s benefits and risks.

Objective

This study sought to describe the experience of benefit and risk assessment for people with type 2 diabetes when making treatment decisions.

Methods

This study utilized qualitative research methods. Individual interviews were conducted using a semi-structured interview guide. Both purposeful and theoretical sampling was used. A grounded theory approach was employed to facilitate data collection and analysis.

Results

The 18 study participants were on varying treatment regimens for diabetes (diet therapy, oral medications, and insulin). Many people felt that they had not received enough information about the benefits and risks of treatment at the point of decision-making and later sought this information on their own. Participants did not seem to consciously assess treatment benefits and risks when treatments were prescribed or suggested, but rather continued to make decisions after the clinical encounter by means of experimentation or experience with treatments. In general, benefits and risks were conceptualized very broadly, and some people were not able to verbally articulate their perceptions of treatment benefits and risks.

Conclusion

Patients’ assessment of treatment benefits and risks is an ongoing, often unconscious process that requires continuous interaction with the health care system. Access to information and an opportunity to discuss treatment options with health care providers are important to people with diabetes when making treatment decisions.

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References

1. Millar W, Young T. Tracking diabetes: prevalence, incidence, and risk factors. Health Reports 2003; 14(3):35-47.
2. Dawson KG, Gomes D, Gerstein H, Blanchard JF, Kahler KH. The economic cost of diabetes in Canada, 1998. Diabetes Care 2002; 25(8):1303- 1307.
3. Astrom K, Carlsson J, Bates I, Webb DG, Duggan C, Sanghani P et al. Desire for information about drugs. A multi-method study in general medical inpatients. Pharmacy World & Science 2000; 22(4):159-164.
4. Berry DC, Michas IC, Gillie T, Forster M. What do patients want to know about their medicines and what do doctors want to tell. Psychol Health
1997; 12:467- 480.
5. Berry DC, Knapp P, Raynor DK. Provision of information about drug side-effects to patients. Lancet 2002; 359(9309):853-854.
6. Enlund H, Vainio K, Wallenius S, Poston JW. Adverse drug effects and the need for drug information. Med Care 1991; 29(6):558 -564.
7. Ziegler DK, Mosier MC, Buenaver M, Okuyemi K. How much information about adverse effects of medication do patients want from physicians? Arch Intern Med 2001; 161(5):706-713.
8. Creswell J. Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, California: Sage; 1998.
9. Strauss A, Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. Second ed. Thousand Oaks, CA: Sage; 1998.
10. Byrne M. Grounded theory as a qualitative research methodology. AORN Journal 2001;73(6):1155-1156.
11. Green J. Commentary: Grounded theory and the constant comparative methods. BMJ 1998; 316:1064- 1065.
12. Giacomini MK, Cook DJ, for the Evidence-Based Medicine Working Group. Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA: The Journal of the American Medical Association 2000; 284(3):357.
13. Creswell J. Qualitative procedures. Research design: qualitative, quantitative, and mixed methods approaches. 2nd ed. Thousand Oaks: Sage; 2003. 179- 207.
14. NVivo. Version 2.0. 1999. QSR International Pty. Ltd
15. Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity 2002:36:391- 409.
16. Paterson B, Thorne S, Dewis M. Adapting to and managing diabetes. Image J Nurs Sch 1998;30(1):57-62.
17. Whittemore R, Chase SK, Mandle CL, Roy C. Lifestyle change in type 2 diabetes a process model. Nursing Research 2002; 51(1):18- 25.
18. Kleinman A. The illness narratives: Suffering, healing, and the human condition. Basic Books;1989.
19. Maclean HM, Goldman JB. A decade of qualitative research on diabetes: A review and synthesis. Can J Diabetes Care 2000; 54- 63.
20. Gillibrand W, Flynn M. Forced externalization of control in people with diabetes: a qualitative exploratory study. Journal of Advanced Nursing 2001; 34(4):501- 510.
21. Frandsen KB, Kristensen JS. Diet and lifestyle in type 2 diabetes: the patient's perspective. Practical Diabetes International 2002; (3):77-80.
22. Hunt LM, Pugh J, Valenzuela M. How patients adapt diabetes self-care recommendations in everyday life. Journal of Family Practice 1998;46(3):207-215.
23. Golin CE, DiMatteo MR, Gelberg L. The role of patient participation in the doctor visit.Implications for adherence to diabetes care. Diabetes Care 1996; 19(10):1153-1164.
24. Hunt L, Valenzuela M, Pugh J. NIDDM patients' fears and hopes about insulin therapy. The basis of patient reluctance. Diabetes Care 1997; 20(3):292-298.
25. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy & Therapeutics 2001; (5):331- 342.
26. Kravitz R, Melnikow J. Engaging patients in medical decision making. BMJ 2001; 323:584.
27. McCord EC, Brandenburg C. Beliefs and attitudes of persons with diabetes. Family
Medicine 1995; 27(4):267- 271.
28. Bandura A. Self- efficacy: Toward a unifying theory of behavioral change. Psychological Review 1977; 84:191 -215.
29. Strecher V, Champion V, Rosenstock I. The health belief model and health behavior. In: Gochman D, editor. Handbook of Health Behavior Research. New York: Plenum Press 1997; 71 -91
30.DiClemente C, Prochaska J. Toward a comprehensive transtheoretical model of change. In: Miller WR, Healther N, editors. Treating addictive behaviors. New York:Plenum Press; 1998. 3-24.
31. Harris SB, Ekoe J, Zdanowicz Y, Webster- Bogaert S. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Research & Clinical Practice 2005; 70:90-97.
32. Grams GD, Herbert C, Heffernan C, Calam B,
Wilson MA, Grzybowski S et al. Haida perspectives on living with non -insulin- dependent diabetes. CMAJ 1996; 155(11):1563-
1568.
33. O'Connor PJ, Crabtree BF, Yanoshik MK. Differences between diab etic patients who do and do not respond to a diabetes care intervention: A qualitative analysis. Family Medicine 1997; 29(6):424-428.

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Published

Dec 8, 2018

How to Cite

M Nair, K., AH Levine, M., H Lohfeld, L., & C Gerstein, H. (2018). “I TAKE WHAT I THINK WORKS FOR ME”: A QUALITATIVE STUDY TO EXPLORE PATIENT PERCEPTION OF DIABETES TREATMENT BENEFITS AND RISKS. Journal of Population Therapeutics and Clinical Pharmacology, 14(2). Retrieved from https://jptcp.com/index.php/jptcp/article/view/160