Effective self-management for chronic disorders among older adults is crucial for their health. To be effective, however, there is the need for shared communication and agreed upon goals between health care providers and patients. Heisler and coworkers assessed the relative importance of two dimensions of physician communication--provision of information (PCOM) and participatory decision-making (PDM)--regarding older patients' diabetes self-management and glycemic control. A cross-sectional survey was conducted among 1,588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM, with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n = 1,233), the relationship was assessed between patient self-management and HbA1c values. In separate analyses, PCOM and PDM were each associated with overall diabetes self-management and with all self-management domains, with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence and foot care. PDM alone was associated with exercise and blood glucose monitoring and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values.

VALUE OF STUDY TO READER: Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring. The need for shared decision making among patients and health care providers underlies all self-management efforts with all chronic illnesses, not just diabetes. It remains, however, a missed opportunity in the interactions between many patient/health care providers.

M Heisler et al. Does Physician Communication Influence Older Patients' Diabetes Self-Management and Glycemic Control? Results From the Health and Retirement Study (HRS). Journal of Gerontology A: Biological Science & Medical Science, 2007;62:1435-1442.