title: Overwhelmed patients: a videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters.
abstract: OBJECTIVE
  Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits.
  
  
  METHODS
  Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT).
  
  
  RESULTS
  Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time.
  
  
  CONCLUSIONS
  BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being.
authors.affiliation: Knowledge and Evaluation Research Unit, Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. montori.victor@mayo.edu
authors.forename: Krista
authors.initials: K
authors.lastname: Bohlen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Scoville
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000328:Adult; D003142:Communication; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011788:Quality of Life; D012648:Self Care / Q000523:psychology*; D014741:Video Recording
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