title: Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes.
abstract: OBJECTIVE
  Little is known about how patient-clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control.
  
  
  METHODS
  Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N=1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c.
  
  
  RESULTS
  The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p<0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p<0.05).
  
  
  CONCLUSIONS
  Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient-clinician relationship as well as enhance patient perceived competence, thereby improving clinical control.
  
  
  CONCLUSIONS
  Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes.
authors: Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, USA. jelstonlafat@vcu.edu
authors: Jennifer Elston
authors: JE
authors: Lafata
authors: Heather L
authors: HL
authors: Morris
authors: Elizabeth
authors: E
authors: Dobie
authors: Michele
authors: M
authors: Heisler
authors: Rachel M
authors: RM
authors: Werner
authors: Levent
authors: L
authors: Dumenci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012648:Self Care; D057566:Self Report; D035502:Trust
chemical_list: D006442:Glycated Hemoglobin