How to Limit Information Overload for People Recently Diagnosed with Diabetes: A Guide for Healthcare Professionals

As clinicians, our intention is to provide quality patient care and education to people living with diabetes. However, upon diagnosis, we tend to impart a deluge of “new and critical” information all at once. This may leave a patient feeling overwhelmed, especially those with type 1 or type 2 diabetes who require insulin. Education overload, including a bombardment of recommendations (regarding eating patterns, participation in physical activity, glucose monitoring and insulin delivery options), often triggers negative feelings toward diabetes self-care. Imparting too much information, without considering a person’s goals, may be a potential barrier to helping them achieve improved health outcomes. A person with diabetes (PWD) may become overwhelmed following a diabetes diagnosis, and feel shame, blame, or guilt if they are not following prescriptive guidance. As you may have noticed in your practice, a PWD may not feel comfortable actively participating in their own care or following up with medical appointments if they fear that they are disappointing you as a clinician by not fully embracing all clinical and educational recommendations.

As health care providers, what can we do to improve communication and assist a person with diabetes to navigate a route to engaged self-care and reduce education overload?

Be Aware of “Situational Disorganization” and Its Effects

As proactive clinicians, we consider a person’s abilities, resources, cultural backgrounds, and beliefs when developing diabetes treatment plans. However, we must recognize that a goal of improved glycemic management may feel too vague or too undefined for a PWD. Even those who were confident and organized with daily life prior to a diagnosis of diabetes may suddenly find themselves situationally disorganized. Before the diagnosis, they had structure and direction, then suddenly, with the diagnosis, they find themselves in a circumstance they did not anticipate. Even when fully supported by the health care team, friends and family, this feeling of situational disorganization may be further exacerbated when asked to consider taking insulin and exploring insulin-delivery options. Using non-judgmental language, motivational interviewing, pre-visit agenda setting, and shared decision making can reduce the onset and impact of situational disorganization.

Use Non-Judgmental and Person-First Language

Always use non-judgmental, person-first language when communicating with PWD. ADCES developed an excellent resource¹ to positively address communication barriers. For example, rather than ask, “How long have you been a diabetic” (which puts a label on them or defines a person as a disease), one could ask, “How long have you lived with diabetes?” Simple language modifications can make a huge difference in patient engagement and help us uncover why there may be difficulty with various aspects of care.

Understand a Person’s Motivation

As clinicians, we are result-driven problem solvers. The problem-solving process includes understanding a person’s motivation and perspective to create a path in order to get to the heart of a patient’s health goals. Active listening and effective interviewing techniques can lead to informed and collaborative decision making, resulting in risk reduction and improved health outcomes.

Use The OARS Approach and Motivational Interviewing²

While there are a variety of approaches clinicians, physicians and diabetes care and education specialists use to build rapport with PWD, the OARS approach can help us address concerns in a culturally sensitive and appropriate manner. OARS stands for Open-ended Questions, Affirming, Reflective Listening, and Summarizing. For a more in-depth example of OARS in action, you can read my article here.

Asking open-ended questions starts with an understanding of motivational interviewing (MI). MI is a person-centered communication skill set that supports autonomy and self-efficacy. MI can assist with diffusing defensive responses from the person seeking our medical guidance. One MI technique is to ask open-ended questions that require a person’s permission in order to increase their participation in an active discussion. For example, ask, “What questions do you have for me?” rather than, “Do you have any questions for me?” This method provides a safe environment for meaningful dialogue and improved rapport. Ask specific questions, such as, “What do you find most challenging about your diabetes management?” The person with the lived experience of diabetes will likely be able to share these pain points.

MI encourages the individual to describe the reason for making a behavior change, along with specific steps to achieve their goals. By becoming empowered, the PWD no longer feels the lack of autonomy associated with a clinician telling them what to do and limits information overload.³

Consider Pre-Visit Agenda Setting

Ask the PWD what they would like to discuss prior to or at the start of the appointment. If they are concerned about insurance coverage, they will not focus on a discussion of insulin-delivery options even if you feel it is essential for their care. As the clinician, you can list or describe 2–3 topics for discussion, which includes essential topics from a clinical perspective. For example, ask, “In addition to insulin-delivery options, is there anything else that you would like to discuss at your next appointment?” This will put the person’s mind at ease and will allow you as the health care provider to prepare a collaborative and meaningful agenda.

Employ Shared Decision Making

Using a shared decision-making process^{4 5} will allow the person seeking medical guidance to speak freely while the clinician actively listens. This format allows the PWD to feel heard, decreases anxiety and increases self-confidence in managing diabetes. Collaboration with the care team empowers a PWD to adopt behaviors that may lead to improved health outcomes. Helping a person set small and achievable goals can foster incremental successes, encouragement, and confidence to make other/bigger changes. Rather than discussing a large and overwhelming goal such as “eat healthier,” ask, “What are your thoughts about making a change in your breakfast on weekdays?” It is an excellent way to be collaborative and set the person up for a positive outcome.

For more information on facilitating behavior change in PWD, you can read this article by Hope Warshaw.

In conclusion, when a person feels appreciated, respected, valued, and heard, they are more likely to address their concerns, participate in their care and return for follow-up appointments.⁶ When deciding on critical issues such as insulin-delivery methods for people with type 1 and type 2 diabetes, shared decision making is especially crucial to assure clinical needs are met while supporting the patient’s choices.

The author was compensated for this article.