828-P: Challenges in Care Relationships in Diabetic Setting: The Diabetologists’ Perspective

Purpose: Poor medication adherence in persons with diabetes is a well documented issue, overall leading to worse glycemic control and quality of life. Previous studies have shown that the quality of the patient-provider relationship is a crucial factor for patient diabetes management and self-care. Most of research has focused on patient perspective, with poor attention to providers’ relational skills to handle interpersonal difficulties concerning care challenges. The purpose of the present study was to explore providers’ subjective perspective about care relationship so to detect some clues that may contribute to better manage patient medication adherence.

Methods: A purposive sample of 18 Italian diabetologists participated in the study. Face-to-face interviews on providers’ emotional experience about care relationship were collected, digitally recorded, and transcribed. A computer-aided text analysis based on word co-occurrences was performed through T-Lab software, by using the conceptual model of Emotional Text Analysis. This allowed the identification of thematic domains pertaining to implicit sense-making processes, beyond the cognitive discourse organization.

Results: Six thematic domains were identified across interviews, which respectively referred to: (1) preoccupation, in terms of separation anxiety and desire for contact; (2) control, focused on hypervigilance and conflict management; (3) fear for excessive closeness and effort to distance; (4) proud self-affirmation in opposition to care burden; (5) guilt feelings and over-involvement; (6) strive for achievement and satisfaction gain.

Conclusions: The findings suggest the importance of providers’ awareness about potential defensive strategies in facing care challenges, from distancing to intrusive reactions, which may interfere patient health engagement and capacity to self-regulate in care behaviors, respectively.