When patient-reported experience does not match change in clinical outcomes: A perplexing view from the inside of a diabetes distress intervention.
When patient-reported experience does not match change in clinical outcomes: A perplexing view from the inside of a diabetes distress intervention.
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DOI：
10.1016/j.jdiacomp.2020.107533
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发表时间：
2020-04
影响因子：
3
通讯作者：
Hessler D
中科院分区：
文献类型：
--
作者：
Fisher L;Polonsky W;Bowyer V;Hessler D
评估两臂糖尿病痛苦(DD)减少随机对照试验中参与者经历的组间差异，并确定它们与临床结果(DD和HbA1C减少)的关系。对于患有1型糖尿病且糖化血红蛋白≥7.5%参与T1-Redeem的高DD成人，我们使用10个定性代码评估了干预后对整个计划“帮助”和计划组成部分“帮助”的5分评级，以及开放式反馈声明。我们比较了OnTrack组和Knowit组的反应，OnTrack是一种关注痛苦的干预措施，Knowit是一种教育/管理干预措施。OnTrack中的参与者报告说，与那些参与Knowit的人相比，OnTrack中的人报告了更高的总体计划帮助水平和更大的计划每个组成部分的帮助，更多的团队支持，更少的负面经历，以及更积极和更有意义的团队参与。在两个研究小组中，对帮助的评级与DD和HbA1C的减少无关。正如先前报道的那样，尽管两组的DD和HbA1C都显著降低，但这些发现还是出现了，组间没有差异。研究结果强调了在临床护理中将糖尿病干预的个人经验作为独立的、不同的结果来处理的重要性。个人经历可能并不总是与传统临床指标的变化有关。
To assess between-group differences in participant experiences in a two-arm diabetes distress (DD) reduction RCT and to determine their relationship to clinical outcomes (reductions in DD and HbA1C). For high DD adults with Type 1 diabetes and HbA1c ≥ 7.5% participating in T1-REDEEM, we evaluated post intervention 5-point ratings of overall program “helpfulness” and program component “helpfulness,” along with open-ended feedback statements using 10 qualitative codes. We compared responses of those in OnTrack, a distressed-focused intervention, with KnowIt, an education/management intervention. Those in OnTrack reported significantly higher levels of overall program helpfulness and greater helpfulness of each component of the program, greater group support, far fewer negative experiences, and more active and meaningful group engagement than those who participated in KnowIt. Ratings of helpfulness were unrelated to reductions in DD and HbA1C in both study arms. As previously reported, these findings occurred despite significant reductions in both DD and HbA1C in both arms with no between-group differences. Findings highlight the importance of addressing the personal experience of diabetes interventions in clinical care as separate, distinct outcomes. Personal experience may not always be related to changes in traditional clinical indicators.
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影响因子：
3
作者：
Fisher L;Hessler D;Polonsky W;Strycker L;Masharani U;Peters A
通讯作者：
Peters A
影响因子：
3.5
作者：
Fisher, L.;Hessler, D. M.;Strycker, L. A.
通讯作者：
Strycker, L. A.
影响因子：
4
作者：
O'Cathain, Alicia;Thomas, Kate J
通讯作者：
Thomas, Kate J
影响因子：
3.5
作者：
Deakin, T. A.;Cade, J. E.;Greenwood, D. C.
通讯作者：
Greenwood, D. C.
影响因子：
16.2
作者：
Fisher, Lawrence;Hessler, Danielle;Strycker, Lisa A.
通讯作者：
Strycker, Lisa A.