Provider-Patient Communication and Metabolic Control

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Abstract
OBJECTIVE To determine whether nurses9 and NIDDM patients9 communicationstyles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations. RESEARCH DESIGN AND METHODS A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1 2) attended 3.5 days of diabetes education, 3) returned in 1 mo fora follow-up consultation with a nurse, and (4) returned in 9–12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patientcentered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect. RESULTS The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses9 use of patientcentered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses9 and patients9 communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels. CONCLUSIONS The results suggest that providers9 attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient9s involvement, respecting the patient9s opinion, and offering support) facilitate the patient9s ability to be an active participant in the consultation.

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