Abstract
Objectives
This study investigated the feasibility and acceptability of implementing a screening
tool as a part of routine care and the subsequent screening experiences of patients
and clinicians. Additionally, potential sources of diabetes distress (DD) were identified
in this clinical population.
Methods
Our investigation was a cross-sectional, mixed-methods, convenience sample of 203
patients living with type 1 or type 2 diabetes from 2 Canadian tertiary hospital–based
clinics. The Problem Areas in Diabetes 5 (PAID5) scale was used to assess DD. Structured
telephone interviews of patients with high DD scores and care provider focus group
transcriptions were analyzed using a deductive thematic content analysis.
Results
The prevalence of DD was 45%. Lack of medication coverage (p=0.02) and presence of
neuropathy (p=0.04) were approximately 5- and 2-fold more likely to be predictors
of high DD, respectively. Patient interviews identified DD screening as an opportunity
to share and feel supported but demonstrated their fear of discussing mental health
concerns. Patients found discussion about mental health helpful and often did not
require a referral to a mental health specialist. Staff focus groups discussed screening
as a feasible tool, but also acknowledged barriers and knowledge gaps that preclude
DD screening integration in routine clinical practice. Specialized training for clinicians
may help increase confidence and improve uptake of DD screening into routine clinical
practice.
Conclusions
The prevalence of DD in outpatient care settings is high. Findings suggest that integrating
the PAID5 screening tool into regular clinical practice is feasible by patients and
care providers.
Résumé
Objectifs
L’objectif de notre étude était de déterminer la prévalence et les prédicteurs de
la détresse liée au diabète (DD) et d’explorer la faisabilité et les répercussions
de la mise en œuvre de l’outil de dépistage Problem Areas In Diabetes 5 (PAID5) dans la pratique clinique.
Méthodes
Notre enquête transversale, par méthodes mixtes, portait sur un échantillon de commodité
composé de 203 patients qui vivaient avec le diabète de type 1 ou de type 2 de 2 centres
de soins tertiaires en milieu hospitalier du Canada. Nous avons utilisé l’échelle
PAID5 pour évaluer la DD. Nous avons utilisé l’approche déductive de l’analyse thématique
de contenu pour explorer les entretiens téléphoniques structurés avec des patients
dont les scores de DD étaient élevés et les transcriptions des groupes de discussion
composés de prestataires de soins.
Résultats
La prévalence de la DD était de 45 %. L’absence d’assurance médicaments (p = 0,02)
et la présence de neuropathie (p = 0,04) étaient approximativement et respectivement
5 et 2 fois plus susceptibles d’être des prédicteurs d’une grande DD. Les entretiens
avec les patients nous ont appris que le dépistage de la DD est une occasion pour
eux de partager et de se sentir soutenus, mais ces entretiens nous ont toutefois démontré
leur crainte de parler des problèmes de santé mentale. Les patients ont trouvé utile
la discussion sur la santé mentale et n’ont pas souvent demandé de les diriger vers
un spécialiste en santé mentale. Les groupes de discussion composés du personnel ont
mentionné que le dépistage est un outil réalisable, mais ont aussi reconnu les obstacles
et les lacunes en matière de connaissances qui empêchent d’intégrer le dépistage de
la DD à la pratique clinique courante. Une formation spécialisée des cliniciens peut
contribuer à accroître la confiance et favoriser l’adoption du dépistage de la DD
dans la pratique clinique courante.
Conclusions
La prévalence de la DD dans le contexte des soins externes est élevée. Les résultats
montrent que l’intégration de l’outil de dépistage PAID5 à la pratique clinique courante
est réalisable par les patients et les prestataires de soins.
Keywords
Mots clés
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Article info
Publication history
Published online: August 09, 2022
Accepted:
July 28,
2022
Received in revised form:
July 12,
2022
Received:
March 1,
2022
Identification
Copyright
Crown Copyright © 2022 Published on behalf of the Canadian Diabetes Association.