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Does a simple web-based intervention facilitate the articulation of patients’ unvoiced agenda for a consultation with their diabetologists? A qualitative study
  1. Julia Frost1,
  2. Andy Gibson2,
  3. Obioha Ukoumunne3,
  4. Bijay Vaidya4,5,
  5. Nicky Britten5,6
  1. 1 Medical School, University of Exeter, Exeter, UK
  2. 2 Health and Social Sciences, University of the West of England, Bristol, Bristol, UK
  3. 3 NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
  4. 4 Macleod Diabetes Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  5. 5 Institute for Health Service Research, University of Exeter Medical School, Exeter, UK
  6. 6 PenCLAHRC: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, Exeter, UK
  1. Correspondence to Dr Julia Frost; j.frost{at}


Objective To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist.

Methods and design A qualitative study embedded in a pragmatic pilot randomised controlled trial.

Setting Two city outpatient departments in England.

Participants 25 patients attending a follow-up consultation and 6 diabetologists.

Intervention The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist.

Data collection 25 participants had their consultation with their diabetologist audio-recorded: 12 in the control arm and 13 in the intervention arm; 12 of the latter also had their PACE-D intervention session and a consultation recorded. Semi-structured interviews with 6 diabetologists, and 12 patients (6 in the intervention group and 6 in the control group).

Analysis Thematic discourse analysis undertaken with patient representatives trained in qualitative data analysis techniques.

Results We identified four consultation types: diabetologist facilitated; patient identified; consultant facilitated and patient initiated and patient ignored. We also identified three critical aspects that explained the production and utilisation of the agenda form: existing consultative style; orientation to the use of the intervention and impact on the consultation. Where patients and diabetologists have a shared preference for a consultant-led or patient-led consultation, the intervention augments effective communication and shared decision making. However, where preferences diverge (eg, there is a mismatch in patients' and diabetologists' preferences and orientations), the intervention does not improve the potential for shared decision making.

Conclusion A simple web-based intervention facilitates the articulation of patients’ unvoiced agenda for a consultation with their diabetologist, but only when pre-existing consultation styles and orientations already favour shared decision making. More needs to be done to translate patient empowerment in the consultation setting into genuine self-efficacy.

Trial registration number ISRCTN75070242.

  • health services research
  • patient centred medicine
  • qualitative research

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  • Contributors NB, AG, OU, BV, JF conceived the original study and developed the protocol. JF led the writing of the first draft of the manuscript, with contributions from AG, OU, BV and NB. All authors contributed to the editing and redrafting.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The original protocol for this study and subsequent minor amendments were approved by the NHS Research Ethics Committee North West—Preston (13/NW/0123). ISRCTN5070242.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Transcripts will not be shared in their entirety to protect the anonymity of patients and diabetologists delivering the intervention. However, requests for excerpts of the data will be considered on an individual basis. Please contact the corresponding author.

  • Collaborators Faith Harris-Golesworthy; Jim Harris.

  • Patient consent for publication Obtained.

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