Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes

Objective: Little is known about how patient-clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control. Methods: Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N = 1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c. Results: The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p < 0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p < 0.05). Conclusions: Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient-clinician relationship as well as enhance patient perceived competence, thereby improving clinical control. Practice implications: Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes. (C) 2013 Elsevier Ireland Ltd. All rights reserved.