title: Look who's (not) talking: diabetic patients' willingness to discuss self-care with physicians.
abstract: OBJECTIVE
  Nearly one-half of diabetic patients have glycated hemoglobin A(1c) (HbA(1c)) levels above recommended targets. Effective physician-patient communication improves glycemia and diabetes self-care; however, communication gaps may exist that prevent patients from discussing self-care problems with treatment providers.
  
  
  METHODS
  We assessed diabetic patients' (n = 316, 85% white, 51% female, 71% type 2 diabetes, 59 ± 11 years old, 16 ± 3 years education, 19 ± 13 years diabetes duration, and HbA(1c) = 7.9 ± 1.4%) HbA(1c), frequency of self-care, diabetes-related distress, depressive and anxiety symptoms, coping styles, diabetes quality of life, and self-care communication in the treatment relationship. Multivariate logistic regression models examined the main and interaction effects of health and psychosocial factors associated with patients' reluctance to discuss self-care.
  
  
  RESULTS
  Patients reported positive relationships with their doctors and valued honest communication; however, 30% of patients were reluctant to discuss self-care. Reluctant patients reported less frequent self-care (P = 0.05), lower diabetes quality of life (P = 0.002), and more diabetes-related distress (P = 0.001), depressive symptoms (P < 0.001), and anxiety symptoms (P = 0.001). Patients who reported elevated depressive symptoms, although not necessarily major depression, were more likely to be reluctant to discuss self-care (odds ratio [OR] 1.66 for 10-point change in t score; P < 0.001), whereas patients who were older (OR 0.78 for 10-year change; P = 0.05) and those who used more self-controlled coping styles (OR 0.78 for 10-point change; P = 0.007) were less likely to be reluctant.
  
  
  CONCLUSIONS
  Awareness of elevated depressive symptoms is important in clinical practice given that these patients may be more reluctant to discuss self-care. Interventions and evidence-based approaches are needed to improve both depressive symptoms and physician-patient communication about self-care.
authors.affiliation: Joslin Diabetes Center, Boston, MA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beverly
authors.forename: Om P
authors.initials: OP
authors.lastname: Ganda
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Ritholz
authors.forename: Yishan
authors.initials: Y
authors.lastname: Lee
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Brooks
authors.forename: Nina F
authors.initials: NF
authors.lastname: Lewis-Schroeder
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hirose
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism; D003142:Communication; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011788:Quality of Life; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin