Provider/Patient Communication

The specific goals of this research program are:

1. To develop and evaluate techniques to help clinicians improve their ability to communicate and facilitate behavioral change among their patients with diabetes.
2. To develop written and video materials to empower diabetic patients to take a more active role in their care.

The crux of diabetes care is self-care by the patient, and an extensive literature in the diabetes field grapples with ways to optimize patient behavior. Many providers feel inadequately trained to instruct and facilitate behavioral change in their diabetic patients in areas such as diet and exercise. Partnership, communication and education are all crucial for managing chronic disease. Therefore, we are testing provider-patient communication training and patient empowerment activities. The framework for provider-patient communication we employ is the E4 model of the Bayer Institute for Health Care Communication. In this model, the clinician enters the typical encounter with four communication tasks (engage, empathize, educate, enlist) and two biomedical tasks (find it, fix it). We have chosen the Bayer training approach because it is widely used, can be delivered in small blocks, has been well-received by clinicians, and its training programs are well-established. Regarding behavi oral change, the Bayer model aims to increase clinicians' conviction that specific behavioral change is important in patients as well as to maximize their confidence in changing behavior. The Bayer training is based upon the Stages of Change model of Prochaska and DiClemente, and the technique of brief motivational interviewing, both commonly used in the addictions field.

Empowering the patient to become a more active communicator and participant in his/her care has improved diabetes outcomes in academic sites and certain research settings. However, adaptation and translation to particularly vulnerable populations and settings, in which patients have special needs and resources are limited, has not yet occurred. We aim to address both lack of provider confidence and skill in behavioral change and methods of empowering patients to be active in their care. Our team has the requisite expertise in behavioral change, provider communication, patient empowerment, and multimedia educational techniques to advance research significantly in this area.