Development and Evaluation of a Psychosocial Intervention for Children and Teenagers Experiencing Diabetes (DEPICTED): a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes

Background Diabetes is the third most common chronic condition in childhood and poor glycaemic control leads to serious short-term and life-limiting long-term complications. In addition to optimal medical management, it is widely recognised that psychosocial and educational factors play a key role in improving outcomes for young people with diabetes. Recent systematic reviews of psycho-educational interventions recognise the need for new methods to be developed in consultation with key stakeholders including patients, their families and the multidisciplinary diabetes healthcare team. Methods/design Following a development phase involving key stakeholders, a psychosocial intervention for use by paediatric diabetes staff and not requiring input from trained psychologists has been developed, incorporating a communication skills training programme for health professionals and a shared agenda-setting tool. The effectiveness of the intervention will be evaluated in a cluster-randomised controlled trial (RCT). The primary outcome, to be measured in children aged 4-15 years diagnosed with type 1 diabetes for at least one year, is the effect on glycaemic control (HbA1c) during the year after training of the healthcare team is completed. Secondary outcomes include quality of life for patients and carers and cost-effectiveness. Patient and carer preferences for service delivery will also be assessed. Twenty-six paediatric diabetes teams are participating in the trial, recruiting a total of 700 patients for evaluation of outcome measures. Half the participating teams will be randomised to receive the intervention at the beginning of the trial and remaining centres offered the training package at the end of the one year trial period. Discussion The primary aim of the trial is to determine whether a communication skills training intervention for specialist paediatric diabetes teams will improve clinical and psychological outcomes for young people with type 1 diabetes. Previous research indicates the effectiveness of specialist psychological interventions in achieving sustained improvements in glycaemic control. This trial will evaluate an intervention which does not require the involvement of trained psychologists, maximising the potential feasibility of delivery in a wider NHS context. Trial registration Current Controlled Trials ISRCTN61568050

Patients' understandings of heart attack: implications for prevention of recurrence

Patients' willingness to undertake secondary preventive strategies following heart attack are likely to be affected by their understandings of their condition. This qualitative study explored patients' understandings of heart attack in order to contribute to the design of effective secondary prevention services. In-depth interviews were conducted with 25 patients with myocardial infarction (MI). These data indicate that information received from health professionals encourages patients to view heart attack as an acute event rather than a symptom of a chronic condition and that this understanding provides patients with low motivation for long-term lifestyle change. Patients may benefit from understanding a heart attack as an acute symptom of an underlying disease process which long-term medication and behavioural change can help to check. In order to achieve this, health professionals need to examine patients' understandings of their heart attack and recovery and to provide information about lifestyle which engages with these understandings

Association between primary care practitioner empathy, and risk of cardiovascular events and all-cause mortality amongst patients with type 2 diabetes: a population based prospective cohort study

Abstract Objective: To examine the association between primary care practitioner empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes Design: Population-based cohort study Setting: 49 general practices in the UK Population: 867 individuals with screen-detected type 2 diabetes who were followed up for an average of ten years until 31st December 2014 in the ADDITION-Cambridge trial Exposure: Twelve months after diagnosis, patients assessed practitioner empathy, and their experiences of diabetes care over the preceding year using the consultation and relational empathy (CARE) questionnaire. CARE scores were grouped into tertiles. Main outcome measures: First recorded CVD-event (composite of myocardial infarction, revascularization, non-traumatic amputation, stroke or fatal event) and all-cause mortality was obtained from electronic searches of the GP record, national registers and hospital records. Hazard ratios (HR) were estimated using Cox models adjusted for confounders Results: Of the 628 participants who completed the CARE score, 120 (19%) experienced a CVD event and 132 participants (21%) died during follow up. In multivariable models, compared to the lowest tertile higher empathy scores were associated with lower risk of CVD events (although this did not achieve statistical significance) and lower risk of all-cause mortality (HR for the middle and highest tertiles respectively: 0.49, 95% CI 0.27 to 0.88, p=0.01 and 0.60, 95% 0.35 to 1.04, p=0.05). Conclusion: Positive patient experiences of practitioner empathy in the year following diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand how and which aspects of patient perceptions of empathy might influence outcomes and to incorporate this understanding into education and training of practitionersThe ADDITION trial is supported by the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme: MC_UU_12015/4)), the Wellcome Trust (grant reference no: G061895), the NIHR Health Technology Assessment Programme (grant reference no: 08/116/300), Diabetes UK and National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks)

Association between primary care practitioner empathy, and risk of cardiovascular events and all-cause mortality amongst patients with type 2 diabetes: a population based prospective cohort study

Abstract Objective: To examine the association between primary care practitioner empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes Design: Population-based cohort study Setting: 49 general practices in the UK Population: 867 individuals with screen-detected type 2 diabetes who were followed up for an average of ten years until 31st December 2014 in the ADDITION-Cambridge trial Exposure: Twelve months after diagnosis, patients assessed practitioner empathy, and their experiences of diabetes care over the preceding year using the consultation and relational empathy (CARE) questionnaire. CARE scores were grouped into tertiles. Main outcome measures: First recorded CVD-event (composite of myocardial infarction, revascularization, non-traumatic amputation, stroke or fatal event) and all-cause mortality was obtained from electronic searches of the GP record, national registers and hospital records. Hazard ratios (HR) were estimated using Cox models adjusted for confounders Results: Of the 628 participants who completed the CARE score, 120 (19%) experienced a CVD event and 132 participants (21%) died during follow up. In multivariable models, compared to the lowest tertile higher empathy scores were associated with lower risk of CVD events (although this did not achieve statistical significance) and lower risk of all-cause mortality (HR for the middle and highest tertiles respectively: 0.49, 95% CI 0.27 to 0.88, p=0.01 and 0.60, 95% 0.35 to 1.04, p=0.05). Conclusion: Positive patient experiences of practitioner empathy in the year following diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand how and which aspects of patient perceptions of empathy might influence outcomes and to incorporate this understanding into education and training of practitionersThe ADDITION trial is supported by the Medical Research Council (grant reference no: G0001164 and Epidemiology Unit programme: MC_UU_12015/4)), the Wellcome Trust (grant reference no: G061895), the NIHR Health Technology Assessment Programme (grant reference no: 08/116/300), Diabetes UK and National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks)