Understanding care relationships in diabetes practice: A psychodynamic interview-based exploratory study

PLoS One. 2022 Feb 17;17(2):e0263226. doi: 10.1371/journal.pone.0263226. eCollection 2022.

Abstract

Objective: To explore the subjective experience of physicians working in diabetic settings about their care relationships in order to find some unique clues contributing to physician professional health and capacity to manage patients' adherence.

Research design and methods: An interview-based exploratory study has been carried out involving 18 physicians (77.8% female) with at least 3 years of clinical practice in diabetes care. In-depth interviews about the emotional experience with patients with diabetes were conducted and audio recorded. Interviews transcripts were analyzed through a computer-based text analysis which allowed the identification of thematic domains (Cluster Analysis) and latent factors (Correspondence Analysis) viewed through a psychodynamic and constructivist lens.

Results: Six thematic domains emerged respectively referring to: Concern (8.43%), Control (14.42%), Ambivalence (22.08%), Devotion (22.49%), Guilt (19.29%) and Strive for Achievement (13.30%). Moreover, three latent dimensions were taken into account, which explained 69.20% of data variance: Affect Repression (28.50%), Tendency to Repair (22.70%) and Anxiety Pattern (18.00%).

Conclusions: Overall, the results of the present study confirm the challenging nature of diabetes care. In particular, physicians ongoing effort to restore patients' psychological integrity in chronic condition constitute the most novel finding above all. In this regard, the need for emotional labor in physicians' education and training is suggested in order to both prevent burnout symptoms (e.g. depersonalization) and promote shared decision making in care relationships. However, findings should be treated as preliminary given the convenience nature of the sample and its reduced size.

MeSH terms

  • Adult
  • Diabetes Mellitus / therapy*
  • Emotions / physiology*
  • Female
  • Guilt*
  • Humans
  • Male
  • Patient Compliance / statistics & numerical data*
  • Physician-Patient Relations*
  • Physicians / psychology*
  • Practice Patterns, Physicians' / trends*

Grants and funding

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.