Kate McCarthy

What characterises diabetes distress and its resolution? A documentary analysis

Abstract Objective Cross-sectional studies show that diabetes distress (DD) is associated with HbA1c and depressive symptoms in individuals with Type 1 and Type 2 diabetes. Evidence of association with self-management behaviour is contradictory. Little qualitative evidence exists to understand the manifestation of DD. Our objective was to understand the documented experience of DD and its resolution. Methods A psycho-social care clinic using evidence-based approaches was developed in a hospital diabetes centre serving Type 1 and Type 2 diabetes populations. People were referred by specialist diabetes clinicians when they were ‘struggling to cope’ with their diabetes. Detailed clinical notes captured the origins, characteristics and process of resolution of referred patients’ DD. Documentary clinical notes retrospective analysis used directed content analysis. DD was assessed by the Problem Areas in Diabetes Scale (PAID) at referral. Results Eighty-two people were referred and 70 people attended 202 consultations. Forty-one sets of case notes were included where people attended ≥2 appointments; of whom, 24 experienced elevated DD, 13 had elevated DD plus established psychological morbidity and 4 had general distress unrelated to their diabetes. Mean PAID score was 53. Individuals with DD only experienced mastery of their diabetes, using the psycho-social care service to increase self-care behaviours. Individuals with DD plus established psychological morbidity were unable to increase their self-care. Conclusions People ‘struggling to cope’ are most likely to be experiencing elevated DD only. People with DD only were able to resolve this through access to clinic-run psycho-social care. Practice Implications Health professionals should routinely assess for coping and distress in their care planning. Psycho-social care pathways are important for people with elevated DD.

Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction

Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post‐mastectomy breast reconstruction.

Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients.

Background Patients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health. Methods Between April 2010 and January 2013, 143 CKD stage-5 or CKD5d patients (age 46.0±1.1y, 62.2% male), were recruited prospectively. A control group of 83 healthy individuals treated for essential hypertension (HTN; age 53.2±0.9y, 48.22% male) were recruited at random. All patients completed the SF-36 health survey questionnaire, echocardiography, vascular tonometry and cardiopulmonary exercise testing. Results Patients with CKD had significantly lower SF-36 scores than the HTN group; for physical component score (PCS; 45.0 vs 53.9, p<0.001) and mental component score (MCS; 46.9 vs. 54.9, p<0.001). CKD subjects had significantly poorer exercise tolerance and cardiorespiratory performance compared with HTN (maximal oxygen uptake; VO2peak 19.9 vs 25.0ml/kg/min, p<0.001). VO2peak was a significant independent predictor of PCS in both groups (CKD: b = 0.35, p = 0.02 vs HTN: b = 0.27, p = 0.001). No associations were noted between PCS scores and echocardiographic characteristics, vascular elasticity and cardiac biomarkers in either group. No associations were noted between MCS and any variable. The interaction effect of study group with VO2peak on PCS was not significant (ΔB = 0.08; 95%CI -0.28–0.45, p = 0.7). However, overall for a given VO2peak, the measured PCS was much lower for patients with CKD than for HTN cohort, a likely consequence of systemic uremia effects. Conclusion In CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.

Types of vicarious learning experienced by pre-dialysis patients.

Objective: Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m2. Renal disease can be familial, and the majority of patients have considerable health service experience when they approach these treatment decisions. Factors affecting patient treatment decisions are currently unknown. The objective of this article is to explore data from a wider study in specific relation to the types of vicarious learning experiences reported by pre-dialysis patients. Methods: A qualitative study utilised unstructured interviews and grounded theory analysis during the participant’s pre-dialysis year. The interview cohort comprised 20 pre-dialysis participants between 24 and 80 years of age. Grounded theory design entailed thematic sampling and analysis, scrutinised by secondary coding and checked with participants. Participants were recruited from routine renal clinics at two local hospitals when their estimated glomerular filtration rate was between 15 and 30 mL/min/1.73 m2. Results: Vicarious learning that contributed to treatment decision-making fell into three main categories: planned vicarious leaning, unplanned vicarious learning and historical vicarious experiences. Conclusion: Exploration and acknowledgement of service users’ prior vicarious learning, by healthcare professionals, is important in understanding its potential influences on individuals’ treatment decision-making. This will enable healthcare professionals to challenge heuristic decisions based on limited information and to encourage analytic thought processes.