Conceptual framework and responding approach of treatment burden of type 2 diabetes mellitus: A video recording-based qualitative analysis^☆

Abstract

Background: Patients with type 2 diabetes mellitus (T2DM) frequently face a considerable treatment burden. Research on the specific treatment burden associated with T2DM is still in its early stages both in China and worldwide.
Objective: Based on video recordings of clinical diagnostic and therapeutic scenarios, this study aims to summarize the conceptual framework of treatment burden related to T2DM among patients in China Mainland and explore proactive coping strategies of general practitioners (GPs).
Methods: The researchers conducted a retrospective qualitative analysis using video records that filmed during 2018-2019 from general practice training clinics of a standardized training base in Guangdong Province of China. This analysis was integrated with the existing conceptual framework of treatment burden, employing qualitative research methods such as observational record forms, field notes, coding extraction and thematic analysis.
Results: From 25 video records, 49 instances of doctor-patient communication related to the treatment burden of T2DM were selected and analyzed. All six themes from the original conceptual framework were explored. Additionally, the researchers identified two additional thematic items (medical information burden and drug-induced hypoglycemia). The finding led to the development of a modified conceptual framework for the treatment burden of T2DM, encompassing seven observable dimensions: financial burden, medication burden, medical management burden, lifestyle change burden, healthcare system burden, time/travel burden, and medical information burden. Each sub-theme's definition was expanded accordingly. The consultation process analysis indicated that trained GPs can actively respond to treatment burdens (medication burden, medical information burden, time/travel burden, lifestyle change burden) using skills such as patient education, enhanced communication, shared decision-making and motivational interviewing.
Conclusion: The study constructs a modified conceptual framework for the treatment burden of T2DM. By integrating the identification of conceptual dimensions in clinical diagnosis and treatment, it explores how Chinese GPs can use doctor-patient communication skills to proactively address specific treatment burdens of T2DM patients.

Keywords

Treatment burden / Patient experience / Patient reported outcome measures / Diabetes mellitus, type 2 / Patient-physician communication / Chronic disease / Video analysis

Declarations

Not applicable.

Authors' contributions

Conceptualization, L.K. and Y.M.; Methodology, L.K. and Y.M.; Datacollection, L.K. and C.Z.; Formal analysis, L.K., Y.M., J.X. and L.R.; Funding acquisition, not applicable; Project administration, L.K. and Y.M.; Resources, not applicable; Supervision, C.Y.; Validation, C.Y.; Writing—original draft, L.K. and Y.M.; Writing—review and editing, C.Y.and M.S. All authors have read and agreed to the published version ofthe manuscript.

Ethics approval and consent to participate

The study received approval from The First Affiliated Hospital of Shantou University Medical College Ethics Review Committee (No. B-2022-238).

Consent for publication

Not applicable.

Availability of data and materials

To protect patient privacy, the original video data from this study is encrypted and stored in the institutional data management platform. Data and materials used in the study will be managed and shared according to the standards and norms of scientific research.

Competing interests

The authors declare that they have no competing interests.

Acknowledgements

Not applicable.

Authors' other information

https://orcid.org/0000-0003-4076-4972 (L.K.)

https://orcid.org/0000-0002-8208-4951 (C.Y.).

References

[1] National Health Service. Long Term Conditions Compendium of Information. The United Kingdom; 2012 third edition. [Internet]. May 30 [cited 2022 Aug 1]. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf.

[2] Bao HL, Liu JR, Ye J. Influencing factors of the diabetes distress among Chinese patients with type 2 diabetes mellitus. Psychiatr Danub. 2018; 30(4):459-465. doi: 10.24869/psyd.2018.459.

[3] Demain S, Gonçalves AC, Areia C, et al. Living with, managing and minimising treatment burden in long term conditions: a systematic review of qualitative research. PLoS One. 2015; 10(5):e0125457. doi: 10.1371/journal.pone.0125457.

[4] Eton DT, Elraiyah TA, Yost KJ, et al. A systematic review of patient-reported measures of burden of treatment in three chronic diseases. Patient Relat Outcome Meas. 2013; 4:7-20.

[5] Salisbury C, Man MS, Bower P, et al. Management of multimorbidity using a patientcentred care model: a pragmatic cluster-randomised trial of the 3D approach. Lancet. 2018; 392(10141):41-50. doi: 10.1016/S0140-6736(18)31308-4.

[6] Lin K, Guo LH, Huang ZH, et al. Sinicization, reliability and validity of the simplified Chinese Treatment Burden Questionnaire for chronic disease. Chinese Journal of General Practice. 2022; 20(6):974-977 1011.

[7] Dobler CC, Harb N, Maguire CA, et al. Treatment burden should be included in clinical practice guidelines. BMJ. 2018;363:k4065. doi: 10.1136/bmj.k4065.

[8] Dou LY, Huang J, Zhang ZX, et al. Recent advances in treatment burden of multimorbidity in elderly patients. (Chinese). Chinese General Practice. 2020; 23(7):874-879.

[9] Hummers-Pradier E, Beyer M, Chevallier P, et al. Categories, research needs, and applicable methods in general practice research: Chinese abstract translation of “Research Agenda for General Practice /Family Medicine and Primary Health Care in Europe ”. Translated by Family Medicine and Community Health Young Editorial Committee Scientific Translation Group. (Chinese). Chinese General Practice. 2022; 25(9):1127-1139. doi: 10.12114/j.issn.1007-9572.2022.02.006.

[10] Haider S, Kawkgi OE, Clark J, et al. Beyond hemoglobin A1c: a videographic analysis of conversations about quality of life and treatment burden during clinical encounters for diabetes care. Endocrine. 2021; 73(3):573-579.

[11] Chinese Medical Doctor Association. Standardized Training Content and Standards for Resident Physicians (2022 Edition). Published August 5, 2022. Accessed December 17, 2022. Available from: https://ccgme-newslogin.oss-cn-beijing.aliyuncs.com/upload/2022/08/05/b500e4aff91543f29c854c69c461f1c4.pdf.

[12] Sav A, Salehi A, Mair FS, et al. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol. 2017; 17(1):140.

[13] May CR, Eton DT, Boehmer K, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014; 14:281. doi: 10.1186/1472-6963-14-281.

[14] Eton DT, Ridgeway JL, Egginton JS, et al. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions. Patient Relat Outcome Meas. 2015; 6:117-126. doi: 10.2147/PROM.S78955.

[15] Eton DT, Linzer M, Boehm DH, et al. Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study. BMC Fam Pract. 2020; 21(1):221.

[16] Orozco-Beltrán D, Artola S, Jansà M, et al. Impact of hypoglycemic episodes on healthrelated quality of life of type-2 diabetes mellitus patients: development and validation of a specific QoLHYPO@questionnaire. Health Qual Life Outcomes. 2018; 16(1):52. doi: 10.1186/s12955-018-0875-1.

[17] Østenson CG, Geelhoed-Duijvestijn P, Lahtela J, et al. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med. 2014; 31(1):92-101.

[18] Jodar-Gimeno E, Álvarez-Guisasola F, Ávila-Lachica L, et al. Quality of life and fear for hypoglycemia in patients with type 2 diabetes mellitus. Revista Clínica Espaiola Engl Ed. 2015; 215(2):91-97.

[19] May C, Montori VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009;339:b2803. doi: 10.1136/bmj.b2803.

[20] Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021; 13(2):201-216.

[21] Yu HY, Wei Y, Jin GH, et al. Survey on consultation length and waiting time of community general practice clinics. (Chinese). Chinese Journal of General Practitioners. 2019; 18(6):541-546.

[22] Bai XF, Ge CY, Zhao YL. The analysis of consultation time of outpatients in a community health service center in Beijing. (Chinese). Continuing Medical Education. 2019; 33(10):165-167. doi: 10.3969/j.issn.1004-6763.2019.10.088.