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Stanford, California 94025


Purpose:

The purpose of this study is to test the efficacy of a novel intervention for physicians to increase awareness about interacting with patients with pre- diabetes, diabetes, and hypertension. The investigators will measure health outcomes in patients as well as patient and physician satisfaction at Stanford Corporate clinics. The doctor-patient relationship has been shown to positively impact not only patient satisfaction, but also patients' physiological health outcomes. Thus, the investigators hypothesize that improving the patient-provider relationship would increase physician efficacy in regards to communicating and mitigating long-term risks to patients at risk for or suffering from chronic illness. The present study develops and tests a mindset intervention for physicians aimed at helping physicians prioritize connecting with their patients both in addition to and in comparison with a communication skills training for physicians.


Study summary:

Healthcare providers at seven Stanford clinic sites will be the investigators' main participants and the study will follow a wait-list control design. The investigators will track outcomes of patients with pre-diabetes, diabetes, or hypertension of participating providers. The intervention described in this study will only be for physicians. The investigators will track both physician outcomes (using self-report survey measures) and patient outcomes (using health information already being collected by the clinic in addition to electronic self-report surveys we will distribute). Although the investigators will be tracking the outcomes of all physicians at the clinics, only patients with pre-diabetes, diabetes, or hypertension will have their outcomes tracked as part of this study. The study will begin with physicians filling out baseline self-report surveys online and/or in person. At Stanford Employer Based Clinics: The initial, baseline data collection phase of the study will involve recruiting 30 patients with pre-diabetes, diabetes, or hypertension per participating physician. Patients with pre-diabetes, diabetes, or hypertension will be identified via either 1) a biometrics screen blood test; 2) a primary care screening blood test; or 3) chart review. Once these patients are identified, they will be asked if they would like to participate in a study about their healthcare at the clinic. Those who say yes will have their contact information sent to the research team, who will contact them via e-mail to send the consent form and initial survey. Then, patients will have a standardized consultation with their primary care physician and then a standardized follow-up visit. Patient satisfaction will be assessed after each visit with their physician. These patients will then be tracked for an additional 3 months, so that patient outcomes are tracked for approximately 6 months total. At all participating clinics: Prior to delivering the intervention, the clinics will be split, and half of the clinic sites will be assigned to receive only a communication skills training (corporate clinics), while the other half of sites will receive this training + a mindset intervention. After physicians complete these trainings, the investigators will once again recruit and track the outcomes of 30 patients with pre-diabetes per participating physician for 3-24 months, using the two standardized visit procedures described above. The intervention for physicians will be delivered in person by members of the research team. Physicians will be told that the investigators are assessing several training programs and that they will all receive all the trainings at some point. Physicians will truthfully be informed that the training they are receiving is designed to enhance their interactions with patients. - Condition 1: Skills condition: This condition will consist of a training for physicians in communication and/or health coaching. Physicians at Stanford Corporate Clinics will receive the communication training. - Condition 2: Skills + mindset intervention condition: This condition will consist of condition 1 plus the addition of a two-hour mindset training and one-hour follow-up for all members of the care team. Questionnaires: Physicians: Physicians will be asked to fill out an initial brief survey about their mindsets about connecting with patients, burnout, job satisfaction, and their knowledge of motivational interviewing for pre- diabetes patients. Physicians will then be asked to fill out the same survey after receiving their training. Physicians will then also be asked to fill out very brief surveys after their clinic visits with pre- diabetes participants. This survey will assess whether or not they felt they were successfully able to communicate with patients regarding the risk of diabetes the patients face. Patients: Patients will be asked to fill out brief surveys before and after their clinic visits with their physicians to assess their baseline knowledge of their risk for diabetes and then their post-visit knowledge, as well as their satisfaction with their visit. Only patients at the Employer-based clinics will be surveyed. Predictions: The investigators expect that physicians in the skills + mindset intervention condition will have the most successful interactions with their patients in terms of effectively communicating risk and encouraging behaviors and treatments that can prevent diabetes onset or help manage diabetes and hypoertension. The investigators expect that patients of these physicians will also fare better than patients of physicians in other condition. The investigators hypothesize benefits will be seen in the following areas: 1. Physician satisfaction with visit 2. Physician feelings of efficacy 3. Patient satisfaction with visit 4. Patient knowledge of risk factors for diabetes and behaviors that can offset those risks 5. Patient adherence to medical treatment 6. Patient adherence to behavioral recommendations, such as diet and exercise 7. Patient health outcomes: hemoglobin A1c, BMI, fasting sugar 8. Patient anxiety and depression 9. Patient retention with new physician Physicians will be informed that the training they are receiving is aimed to help improve their clinical skills for communicating with patients with pre-diabetes, diabetes, or hypertension. Physicians will have the option to remove their data from analysis at any time if they wish. Data from the electronic medical record will be used to assess patient health outcomes at all clinics.


Criteria:

Inclusion Criteria: - Patients will be screened and included if they have diabetes, hypertension, or pre-diabetes Exclusion Criteria:


NCT ID:

NCT03677609


Primary Contact:

Study Director
Kari Leibowitz, MA
Stanford University


Backup Contact:

N/A


Location Contact:

Stanford, California 94025
United States



There is no listed contact information for this specific location.

Site Status: N/A


Data Source: ClinicalTrials.gov

Date Processed: February 04, 2019

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