title: The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management.
abstract: OBJECTIVE
  Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients' diabetes self-management. This study assessed the influence of patients' evaluation of their physicians' participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management.
  
  
  METHODS
  We surveyed 2,000 patients receiving diabetes care across 25 Veterans' Affairs facilities. We measured patients' evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; alpha = 0.96), rating of providers' communication with a 5-item scale (Provider Communication [PCOM]; alpha = 0.93), understanding of diabetes self-care with an 8-item scale (alpha = 0.90), and patients' completion of diabetes self-care activities (self-management) in 5 domains (alpha = 0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding.
  
  
  RESULTS
  Sixty-six percent of the sample completed the surveys (N = 1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P < .01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized beta: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized beta: 0.10; P =.004). Understanding was strongly and independently associated with self-management (standardized beta: 0.25; P < .001).
  
  
  CONCLUSIONS
  For these patients, ratings of providers' communication effectiveness were more important than a participatory decision-making style in predicting diabetes self-management. Reported understanding of self-care behaviors was highly predictive of and attenuated the effect of both PDMstyle and PCOM on self-management, raising the possibility that both provider styles enhance self-management through increased patient understanding or self-confidence.
authors.affiliation: Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Mich, USA. mheisler@umich.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Reynard R
authors.initials: RR
authors.lastname: Bouknight
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.forename: Dylan M
authors.initials: DM
authors.lastname: Smith
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000368:Aged; D003142:Communication; D003657:Decision Making; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012494:Sampling Studies; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome