THE ROLE OF PATIENT PARTICIPATION IN THE DOCTOR VISIT - IMPLICATIONS FOR ADHERENCE TO DIABETES CARE

For patients, treatment of diabetes involves complex changes in basic behaviors and adherence to complicated regimens. Understanding the fac tors that enable patients to adhere to diabetes treatment is the first step to designing effective interventions. Researchers of diabetes ca re have postulated that increasing diabetic patients' participation in medical decision making during the doctor visit is likely to improve their adherence to self-care. However, a critical review of the impact of patient participation on diabetic patients' adherence to self-care is absent from the literature. We review the subject of patient parti cipation in medical decision making and its effect on adherence to sel f-care for patients with diabetes. We introduce a model of the determi nants of adherence to diabetes self-care that incorporates the effects of patient participation in medical decision making. In this model, w e suggest three ways that patient participation can affect adherence t o self-care: 1) it may have a direct effect; 2) it may affect adherenc e to self-care indirectly by affecting patients' understanding of thei r treatment regimen or the fit of their regimen with their lifestyle; and 3) perceived omissions of participation can affect adherence to se lf-care indirectly through an effect on patient satisfaction. Research is needed to identify more clearly which components of patient partic ipation affect adherence to self-care and in what ways. Distinguishing patient and physician behaviors that contribute to the process of pat ient participation would provide a means to develop specific behaviora l interventions.