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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References
- Diabetes and mental health.Can J Diabetes. 2018; 42: S130-S141
- Decreased quality of life in individuals with type 2 diabetes mellitus is associated with emotional distress.Int J Environ Res Public Health. 2019; 16: 2652
- Putting PAID to diabetes-related distress: The potential utility of the Problem Areas In Diabetes (PAID) scale in patients with diabetes.Psychosomatics. 2013; 54: 44-51
- Prospective associations between emotional distress and poor outcomes in type 2 diabetes.Diabetes Care. 2012; 35: 2472-2478
- Diabetes distress, depression and glycemic control in a Canadian-based specialty care setting.Can J Diabetes. 2017; 41: 362-365
- Psychosocial problems and barriers to improved diabetes management: Results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) study.Diabet Med. 2005; 22: 1379-1385
- Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses.Diabetes Care. 2010; 33: 23-28
- The prevalence of diabetes-specific emotional distress in people with type 2 diabetes: A systematic review and meta-analysis.Diabet Med. 2017; 34: 1508-1520
- Diabetes Attitudes, Wishes and Needs second study (DAWN2TM): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes.Diabet Med. 2013; 30: 767-777
- Diabetes distress: Understanding the hidden struggles of living with diabetes and exploring intervention strategies.Postgrad Med J. 2015; 91: 278-283
- Should we screen for emotional distress in type 2 diabetes mellitus?.Nat Rev Endocrinol. 2009; 5: 665-671
- Factors associated with diabetes-related distress: Implications for diabetes self-management.Soc Work Health Care. 2014; 53: 364-381
- Association of diabetes-related emotional distress with diabetes treatment in primary care patients with type 2 diabetes.Diabet Med. 2007; 24: 48-54
- Predicting diabetes distress in patients with type 2 diabetes: A longitudinal study.Diabet Med. 2009; 26: 622-627
- Depression and diabetes distress in adults with type 2 diabetes: Results from the Australian National Diabetes Audit (ANDA) 2016.Sci Rep. 2018; 8: 7846
- Emotion regulation contributes to the development of diabetes distress among adults with type 1 diabetes.Patient Educ Couns. 2018; 101: 124-131
- Physical symptom complaints, cognitive emotion regulation strategies, self-compassion and diabetes distress among adults with type 2 diabetes.Diabet Med. 2018; 35: 1671-1677
- Screening, evaluation and management of depression in people with diabetes in primary care.Prim Care Diabetes. 2013; 7: 1-10
- Assessment of diabetes-related distress.Diabetes Care. 1995; 18: 754-760
- Look who’s (not) talking: Diabetic patients’ willingness to discuss self-care with physicians.Diabetes Care. 2012; 35: 1466-1472
- Psychosocial care for people with diabetes: A position statement of the American Diabetes Association.Diabetes Care. 2016; 39: 2126-2140
- Short-form measures of diabetes-related emotional distress: The Problem Areas in Diabetes Scale (PAID)-5 and PAID-1.Diabetologia. 2010; 53: 66-69
- IBM SPSS Statistics for Windows version 25.0. IBM Corp, Armonk, NY2017
- Qualitative Research Methods: The Long Interview.Sage Publications, Newbury Park, California1988
- Screening for depression and diabetes-related distress in a diabetes outpatient clinic.Diabet Med. 2013; 30: 88-94
- Diabetes-related burden and distress is low in people with diabetes at outpatient tertiary care level.Exp Clin Endocrinol Diabetes. 2016; 124: 307-312
- Diabetic peripheral neuropathy and depressive symptoms: The association revisited.Diabetes Care. 2005; 28: 2378-2383
- Diabetes-specific emotional distress in people with type 2 diabetes: A comparison between primary and secondary care.Diabet Med. 2014; 31: 1252-1259
- Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes.J Diabetes Complications. 2017; 31: 1318-1324
- The contributors of emotional distress in painful diabetic neuropathy.Diab Vasc Dis Res. 2014; 11: 218-225
- The cost of diabetes in Canada over 10 years: Applying attributable health care costs to a diabetes incidence prediction model.Health Promot Chronic Dis Prev Can. 2017; 37: 49-53
- Adherence to diabetes medication: A systematic review.Diabet Med. 2015; 32: 725-737
- Mediators of medication adherence and glycaemic control and their implications for direct outpatient medical costs: A cross-sectional study.Diabet Med. 2018; 35: 807-815
- Correlates of diabetes-related distress in type 2 diabetes: Findings from the Benchmarking Network for Clinical and Humanistic outcomes in Diabetes (BENCH-D) study.J Psychosom Res. 2015; 79: 348-354
- Glycemic control in insulin-treated patients with type 2 diabetes: Empowerment perceptions and diabetes distress as important determinants.Biol Res Nurs. 2019; 21: 182-189
- The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes.Diabetes Care. 2010; 33: 1034-1036
- The complex interplay between clinical and person-centered diabetes outcomes in the two genders.Health Quality Life Outcomes. 2017; 15: 1-11
- Who’s distressed? A comparison of diabetes-related distress by type of diabetes and medication.Patient Educ Couns. 2018; 101: 1490-1495
- Enablers and barriers to effective diabetes self-management: A multi-national investigation.PLoS One. 2019; 14e0217771
- How self-stigma affects patient activation in persons with type 2 diabetes: A cross-sectional study.BMJ Open. 2020; 10e034757
- Exploring the role of the patient-physician relationship on insulin adherence and clinical outcomes in type 2 diabetes: Insights from the MOSAIc study.J Diabetes. 2017; 9: 596-605
- Monitoring of Individual Needs in Diabetes (MIND)-2: Follow-up data from the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) MIND study.Diabetes Care. 2012; 35: 2128-2132
- Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: A systematic review and meta-analysis.Diabetes Metab Syndr Obesity. 2019; 12: 19-33
- Aspects of culturally competent care are associated with less emotional burden among patients with diabetes.Med Care. 2012; 50: S69-S73
- Depression in diabetes: Have we been missing something important?.Diabetes Care. 2011; 34: 236-239
- Challenges faced by physicians when discussing the type 2 diabetes diagnosis with patients: Insights from a cross-national study (IntroDia®).Diabet Med. 2017; 34: 1100-1107
- The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes.J Adv Nurs. 2012; 68: 391-401
- Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes.Psychol Health Med. 2017; 22: 1118-1126
- Patients’ readiness to receive psychosocial care during nurse-led routine diabetes consultations in primary care: A mixed methods study.Int J Nurs Stud. 2016; 63: 58-64
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.
