867-P: Variation in the Setting of Type 2 Diabetes Diagnosis Disclosure

The disclosure of a new type 2 diabetes (T2D) diagnosis shapes patients’ T2D-related experiences, with more supportive approaches linked with better self-care and lower diabetes distress. Given changes in patient-provider communication and greater use of telemedicine, we examined the setting of T2D disclosures among adults in a large, integrated healthcare delivery system.

Physicians reviewed charts of a random sample of 200 adults diagnosed with T2D between 2014-2018 to determine the diagnosis disclosure setting. Identified settings were an in-person visit, telemedicine visit (telephone/video), secure message via the online patient portal, mailed letter, or voicemail. These settings were further categorized into 2-way synchronous communication (in-person/telemedicine), 2-way asynchronous communication (secure message), and 1-way asynchronous communication (letter/voicemail). We examined differences in disclosure setting by patient demographics.

The disclosure setting was discernible for 197/200 individuals; 55.3% received the diagnosis via 2-way synchronous communication (25.4% in-person, 29.9% telemedicine), 23.9% via 2-way asynchronous communication, and 20.8% via 1-way asynchronous communication (18.8% letter, 2% voicemail). Disclosure setting did not differ by age, gender, or level of neighborhood deprivation. Latinx individuals were overrepresented among those receiving the diagnosis via 1-way asynchronous communication (42.5% vs. 17.1% 2-way synchronous vs. 8.7% 2-way asynchronous, p=0.001) and had lower online patient portal enrollment (59%).

The heterogeneity in T2D diagnosis disclosure setting suggests a lack of standard practices for communicating a T2D diagnosis. The common use of asynchronous modalities is concerning given the gravity of the diagnosis, especially when established best practices for communicating bad news to patients exist.