A grounded theory study to explore how people with Type 2 diabetes and healthcare professionals understand and manage decision-making involving risk

Aims and Objectives: This study explores how patients and clinicians negotiate and manage decision-making involving risks associated with Type 2 diabetes. The purpose of the study was to improve understanding of what is effective when communicating about risks to people with diabetes and how they use information on risk to make decisions about how they manage their diabetes.
Methods: A case study approach (n=6) involving recorded consultations and interviews of a person with diabetes and a practice nurse, was undertaken in three local general practices. Grounded theory methodology was used to investigate the perspectives of nurses and patients managing risk of diabetes complications.
Results
 Patients live with uncertainty which impacts on their behaviour and how they manage risk
 Diabetes creates a social risk for patients which has to be managed in their daily lives
 Practice nurses balance the tensions of formal and informal risk management to meet professional and organisational requirements as well as the expectations of patients
 Effective risk communication may be enhanced by the quality of the nurse-patient relationship, the use of visual metaphors and anecdotes involving ‘similar others’
Conclusions: The study explored perceptions of risk and how this influences diabetes management with a unique perspective from patients and practice nurses in a primary care setting. It suggests that patients and nurses may have unrecognised and competing priorities with regards to managing risk and recommends a review of approaches for diabetes consultations and patient education that are more pragmatic and acknowledge personal time framing of risk.