The realisation of patient-centred care during a 3-year proactive telephone counselling self-care intervention for diabetes

Abstract 

Objective

To explore the way that patient-centred care is realised within a tele-carer behavioural change intervention.

Method

In-depth, semi-structured interviews undertaken at years 1 and 3 with a purposively selected sample from the intervention group within a 3-year randomised controlled trial (RCT) of a telephone-based education and support for persons with type 2 diabetes, and interviews with the non-medically trained tele-carers and supervising diabetes specialist nurse.

Results

A four-phased flow of the patient-centred interactions was identified, which evolved over the process of the intervention. Initially, attention centred on building a picture for and of the patient and assessing their knowledge base. Later, focus moved towards understanding diabetes from the patient's perspective and advice-giving became more individualised. Throughout, the interaction dynamics varied for patients.

Conclusion

This study provides insight into the development of patient-centred behaviours over time and the influence of patients on tele-carer communication styles.

Practice implication

When adopting a patient-centred approach, tele-carers need to be flexible and recognise that patients vary in their knowledge, skills and psychological adaption to diabetes. Continuity of care and consistent contact is pivotal to patients being able to move through the various phases of their illness trajectory and make the transition towards improved self-care management.

Keywords: Patient-centred care, Chronic disease, Type 2 diabetes, Tele-care, Communication, Interactional dynamics, Self-care