Overwhelmed Patients

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

  1. Victor M. Montori, MD, MSC1,3
  1. 1Knowledge and Evaluation Research Unit, Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  2. 2Avera Research Institute & Avera Cancer Institute, Sioux Falls, South Dakota
  3. 3Mayo Medical School, Rochester, Minnesota
  4. 4Division of Health Care and Policy Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
  5. 5School of Health Sciences, University of Southampton, Southampton, England, U.K.
  1. Corresponding author: Victor M. Montori, montori.victor{at}


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 DESIGN AND METHODS 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 represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being.

  • Received June 8, 2011.
  • Accepted October 6, 2011.

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  1. Diabetes Care vol. 35 no. 1 47-49
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