title: The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study).
abstract: OBJECTIVE
  To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams.
  
  
  METHODS
  Pragmatic cluster randomised controlled trial.
  
  
  METHODS
  26 UK secondary and tertiary care paediatric diabetes services.
  
  
  METHODS
  79 healthcare practitioners (13 teams) trained in the intervention (359 young people with type 1 diabetes aged 4-15 years and their main carers) and 13 teams allocated to the control group (334 children and their main carers).
  
  
  METHODS
  Talking Diabetes programme, which promotes shared agenda setting and guiding communication style, through flexible menu of consultation strategies to support patient led behaviour change.
  
  
  METHODS
  The primary outcome was glycated haemoglobin (HbA(1c)) level one year after training. Secondary outcomes were clinical measures (hypoglycaemic episodes, body mass index, insulin regimen), general and diabetes specific quality of life, self reported and proxy reported self care and enablement, perceptions of the diabetes team, self reported and carer reported importance of, and confidence in, undertaking diabetes self management measured over one year. Analysis was by intention to treat. An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training (intervention group) and at one year follow-up (intervention and control group). Two key domains of skill assessment were use of the guiding communication style and shared agenda setting.
  
  
  RESULTS
  660/693 patients (95.2%) provided blood samples at follow-up. Training diabetes care teams had no effect on HbA(1c) levels (intervention effect 0.01, 95% confidence interval -0.02 to 0.04, P=0.5), even after adjusting for age and sex of the participants. At follow-up, trained staff (n=29) were more capable than controls (n=29) in guiding (difference in means 1.14, P<0.001) and agenda setting (difference in proportions 0.45, 95% confidence interval 0.22 to 0.62). Although skills waned over time for the trained practitioners, the reduction was not significant for either guiding (difference in means -0.33, P=0.128) or use of agenda setting (difference in proportions -0.20, -0.42 to 0.05). 390 patients (56%) and 441 carers (64%) completed follow-up questionnaires. Some aspects of diabetes specific quality of life improved in controls: reduced problems with treatment barriers (mean difference -4.6, 95% confidence interval -8.5 to -0.6, P=0.03) and with treatment adherence (-3.1, -6.3 to -0.01, P=0.05). Short term ability to cope with diabetes increased in patients in intervention clinics (10.4, 0.5 to 20.4, P=0.04). Carers in the intervention arm reported greater excitement about clinic visits (1.9, 1.05 to 3.43, P=0.03) and improved continuity of care (0.2, 0.1 to 0.3, P=0.01).
  
  
  CONCLUSIONS
  Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief, team-wide training in consultation skills.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN61568050.
authors.affiliation: South East Wales Trials Unit, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK. roblingmr@cardiff.ac.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Robling
authors.forename: Rachel
authors.initials: R
authors.lastname: McNamara
authors.forename: Kristina
authors.initials: K
authors.lastname: Bennert
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.forename: Sue
authors.initials: S
authors.lastname: Channon
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crowne
authors.forename: Helen
authors.initials: H
authors.lastname: Hambly
authors.forename: Kamila
authors.initials: K
authors.lastname: Hawthorne
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Mirella
authors.initials: M
authors.lastname: Longo
authors.forename: Lesley
authors.initials: L
authors.lastname: Lowes
authors.forename: Tim
authors.initials: T
authors.lastname: Pickles
authors.forename: Rebecca
authors.initials: R
authors.lastname: Playle
authors.forename: Stephen
authors.initials: S
authors.lastname: Rollnick
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.forename: John W
authors.initials: JW
authors.lastname: Gregory
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003258:Consumer Behavior; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D056348:Emotional Intelligence; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006282:Health Personnel / Q000193:education / Q000523:psychology / Q000592:standards; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care; D011361:Professional Competence / Q000592:standards*; D011369:Professional-Patient Relations; D015397:Program Evaluation; D011788:Quality of Life; D013663:Teaching / Q000379:methods / Q000458:organization & administration
chemical_list: D006442:Glycated Hemoglobin