How to Facilitate Behavior Change in People with Diabetes —Tips to integrate person-centered care and shared decision-making into your practice
As clinicians who care for and counsel people with diabetes, we’ve become familiar with the concepts of delivering person-centered care and using shared decision-making. A core goal in the use of these concepts is to identify diabetes management changes and behavior changes a person is willing to tackle.
Clinical standards for diabetes care call for us to apply these care concepts, in part, because diabetes care is unique as a disease state.1,2 Implementation of a diabetes care plan necessitates that the person takes a very active role in their daily self-care that typically requires a multitude of daily demands and decisions. The person with diabetes and/or their care givers must become knowledgeable about diabetes as well as the specifics of their evolving care plan. They then need to be willing and able to realistically integrate this plan into the rest of their life, ideally with ease and minimal mental burden.
It is the willingness and ability of the person with diabetes to take an active role that makes person-centered and shared decision-making care techniques crucial in delivering quality diabetes care. When applied well, these techniques can improve a person’s clinical outcomes and well-being, including mental health and quality of life.2,3
Integrating these concepts into the care we provide is a daily lifelong practice. Here are a few tips to keep in mind whether you’re approaching a person with type 1 or type 2 diabetes.
Consider Lifestyle Factors that Impact Diabetes Management
Offering person-centered care means we consider many other factors at play in each person’s life—usually many. It is important that we regularly remind ourselves to ask a lot of open-ended and specific questions and use validated screening tools and other mechanisms, such as electronic health record flags, to assess Social Determinants of Health (SDoH), diabetes distress, food insecurity, and other life factors and challenges that impact a diabetes management plan and daily self-care behaviors.4
These factors include, but are not limited to:
- social determinants of health (SDoH)
- cognitive abilities
- school/work schedule
- health beliefs
- cultural factors
- eating patterns
- financial concerns
- health insurance coverage
- and literacy and numeracy4
With consideration of pertinent information regarding these factors, apply shared decision-making to determine what a person is able and willing to do based on two-way dialogue and asking vs. telling. Shared decision-making can create a positive and productive partnership as well as increase a person’s chances of successfully executing their care plan and making essential behavior changes slowly and over time.
Ask Open-Ended Questions to Treat the Whole Person
As clinicians it’s important to try to walk a mile in each persons’ shoes and to be both compassionate and empathetic.
Consider initiating visits with one of the person-centered questions listed below. Asking one of these questions before you jump into current clinical management and diabetes-related data and results, can help you quickly assess your patient’s current mental and emotional status along with their wants and desires regarding their diabetes care. Beyond helping you gain insights quickly, taking a few moments to ask one or more of these questions can convey that you care about your patient as a whole person beyond simply their clinical status.
Identify questions that are most comfortable for you to ask and that you find elicit the most insights succinctly. Obviously, time is always a constraint.
- What is currently bugging you the most about managing your diabetes?
- What’s been the most challenging part of managing diabetes lately/since your last visit?
- What is the hardest part of managing your diabetes within your daily life?
- What about living with diabetes day to day takes the most energy for you?
- Tell me about what makes living with diabetes hard for you?
A valuable follow up question that can pave the way to use shared decision-making is: Do you have any thoughts about how we can make changes in your management plan to make the aspect of your self-care you mentioned bug you less or make managing diabetes less burdensome?
Apply Decision-Making as an Ongoing Cycle
The American Diabetes Association (ADA), in their Standards of Care, offers an important figure (4.1), Decision Cycle for Person Centered Glycemic Management in Type 2 Diabetes with the central goals of care being to prevent complications and optimize quality of life.1 This figure presents an ongoing decision cycle with which to implement person-centered care and shared decision-making. Elements of this cycle with examples include:
- Assess key person characteristics, e.g. the individual’s priorities, and motivation, depression, and cognition
- Consider specific factors that impact choice of treatment, e.g. complexity of regimen, and access, cost, and availability of medication
- Utilize shared decision-making to create a management plan, e.g. explore personal preferences, include motivational interviewing and goal setting
- Agree on management plan, using S-M-A-R-T goals for goal setting
- Implement management plan, ensure regular review and more contact initially
- Provide ongoing support and monitoring, e.g. emotional well-being, lifestyle and health behaviors
- Review and agree on management plan, e.g. mutually agree on changes, undertake decision cycle regularly
We realize practicing person-centered care and shared decision-making requires both awareness and emotional intelligence from us as clinicians. When done well, application of these techniques can also help us limit information overload with our patients, as this article by my colleague Susan Weiner MS, RDN, CDN, CDCES, FADCES details. These techniques may not be easy to implement, but honing them over time certainly is worth it as you and the people with diabetes you care for reap the benefits.
The author was compensated for this article.