Overwhelmed patients: A videographic analysis of how patients with type 2 diabetes and clinicians articulate and address treatment burden during clinical encounters

OBJECTIVE - Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits. RESEARCH DESIGNANDMETHODS - Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT). RESULTS - Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time. CONCLUSIONS - BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions representmissed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being.