title: Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia®).
abstract: To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes.
  
  
  
  As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia®), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy).
  
  
  
  A total of 6753 of 9247 eligible physicians completed the IntroDia®survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations.
  
  
  
  Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation.
authors.affiliation: Rotherham Institute for Obesity, Rotherham, UK.|Clifton Medical Centre, Rotherham, UK.
authors.forename: M
authors.identifier: 0000-0002-8196-2505
authors.initials: M
authors.lastname: Capehorn
authors.affiliation: Department of Psychiatry, University of California San Diego, San Diego, USA.|Behavioral Diabetes Institute, San Diego, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Polonsky
authors.affiliation: Division of Endocrinology and Metabolism, University of California San Diego, San Diego, USA.|Veterans Affairs Medical Center, San Diego, USA.
authors.forename: S
authors.initials: S
authors.lastname: Edelman
authors.affiliation: International Diabetes Federation, Brussels, Belgium.|The Michener Institute of Education at UHN, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Belton
authors.affiliation: Somerset Partnership NHS Foundation Trust, Bridgwater, UK.
authors.forename: S
authors.initials: S
authors.lastname: Down
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, USA.
authors.forename: V
authors.initials: V
authors.lastname: Gamerman
authors.affiliation: Boehringer Ingelheim GmbH, Ingelheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Nagel
authors.affiliation: Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Alzaid
mesh_terms: D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy / Q000009:adverse effects; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D000072858:Psychosocial Support Systems; D011788:Quality of Life; D012189:Retrospective Studies; D000073278:Self-Management / Q000193:education; D012727:Sex Characteristics; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology / Q000517:prevention & control*