If healthcare professionals want to foster effective diabetes self management in their patients they need to drop their powerpoint slides and lectures and instead engage in shared decision-making that’s focused on the patient and their individual circumstances, an internationally renowned expert has advised delegates.
Dr Martha Funnell, a recognised leader in the field of diabetes self-management education and psychosocial support, told delegates at the ADS-ADEA Annual Scientific Meeting that facilitating sustained self-management throughout a lifetime of diabetes is a challenge for people with diabetes and health professionals.
The invited speaker, from the University of Michigan Medical School, cited findings from the DAWN 2 study which found that most people with diabetes are not actively engaged by their healthcare professionals to take control of their condition.
Dr Funnell shared with the audience her guiding principles and keys of self-management.
“Self-management occurs within the context of daily life, she explained, “and treatment must accommodate the patient’s goals, priorities, values and barriers”. She highlighted the importance of revising the treatment plan when needed. “If it doesn’t work in the patient’s life, it doesn’t work,” she told delegates.
Strategies for engagement include shared decision-making, asking about what’s going well and what isn’t, and remaining solution neutral and supporting patient decision making. For example, asking ‘What decision did you make?’, ‘Why?’ and ‘What happened as a result?’
A key part of successful engagement is better communication skills, said Dr Funnell. She encourages health professionals to listen actively, empathise and encourage, use question-based learning and to remember to WAIT (Why Am I Talking)?
Diabetes Self-Management Education (DSME) is effective for improving clinical and QOL outcomes, at least in the short-term. And while there is no single best educational program or approach, “Programs that incorporate behavioural and psychosocial strategies, are age, culturally and literacy appropriate, and empowerment-based” improve outcomes, Dr Funnell informed delegates.
Group education is at least as effective as individual education, particularly with group involvement. It has moved from an initial focus on knowledge and “compliance/adherence” as the major outcome, to more recently being focused on behaviour change and strategies to facilitate behaviour change, to most recently recognising the need to address knowledge behaviour and psychosocial aspects, along with providing on-going support, she told the audience.
“No patient I know made changes based on their knowledge of their beta cells”, said Dr Funnell, highlighting the need for more than just knowledge.
She encourages replacing lectures and powerpoint slides with a focus on self-management, responding to questions and engaging patients in decision-making.
“Patients are not interested in the topic of ‘diabetes’ but they are highly interested in their own diabetes”, she told the audience. “It needs to be about them”.
Psychosocial and behavioural support
“Behaviours involved in managing and preventing diabetes are dynamic and multidimensional” Dr Funnell explained.
“The focus should be on HOW to make changes not WHAT to change”, she added. “The ‘Here’s what you should do’ approach is rarely effective and never helpful”.
Instead, healthcare professionals need to collaborate with patients to create a specific self-directed plan to change behaviours in order to achieve goals.
Diabetes-related distress is common but often not addressed, Dr Funnell told delegates.
“In the DAWN2 study, diabetes-distress was reported by 44.6% of participants but only 23.7% reported their healthcare team asked them about how diabetes impacted their life”.
She suggests beginning consultations by asking about what they are currently finding difficult or frustrating, how they are feeling about the issue and what they want to do during their visit to address this concern.
Dr Funnell emphasised the importance of ongoing access to Diabetes Self-Management Support (DSMS) and the need to address barriers that limit access to needed services.
Ongoing DSMS, she explained, is “the activities to assist the person with diabetes to implement and sustain the ongoing behaviours needed to manage their illness”. It can include behavioural, educational, psychosocial and/or clinical support.
Peer support is particularly valuable but peer leaders need to have diabetes and the most effective peers are those who have struggled with their diabetes, not the ‘perfect patients’.
Key messages for the person living with diabetes are that that diabetes is self-managed, not controlled, that ongoing education and support are important, that treatment will change over time and that diabetes self-management involves trial and error.
“DSMS should focus on choices and consequences, not adherence and compliance”, Dr Funnell told the audience.