Wiebke Kantimma, Ashley Metza, Arianne C. van Bonb, Tine Buyla, Giesje Nefsc,d,e,f
- a) Department of Organization Studies, Tilburg University; b) Department of Internal Medicine, Rijnstate Hospital, Arnhem; c) Department of Medical Psychology, Radboud University Medical Center; d) Diabeter, Center for Focused Diabetes Care and Research, Rotterdam; e) Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University; f)
Diabeter Centrum Amsterdam, Amsterdam w.kantimm@tilburguniversity.edu
Background: Advanced diabetes technologies (sensors, pumps, hybrid closed loop) have largely entered clinical practice. Whereas medical and psychological effects of using technology for people with diabetes (pwd) have been studied, less is known about its impact for healthcare professionals (hcp) and their work. Therefore, this study explores hcps’ experiences, cognitions and emotions in working with such technologies.
Methods: We conducted a qualitative case study at a Dutch general hospital, including semi-structured interviews with 8 diabetes-nurses, 3 doctors, 3 dietitians and 3 pwd; and non-participant observations of clinical consultations with pwd (ca. 100 hours). Thematic analysis was conducted.
Results: Participating hcp viewed technologies as useful means to achieve improved medical outcomes and pwds’ quality of life. Despite general enthusiasm, some hcp felt insecure about their knowledge on pumps and algorithms, and whether it is adequate to give tailored advice. Further, hcp formulated uncertainties regarding safety and benefits of pump-use for specific people. Hcp managed technological complexity by defining responsibilities for technology between themselves and pwd. Still, as they felt responsible for pwd, hcp sometimes blurred those responsibilities by conducting tasks they previously defined as responsibility of pwd, e.g. searching for specific settings or calling the manufacturer to address technical issues experienced by pwd. A source of frustration was the exclusion of pwd from accessing technology due to reimbursement regulations and limited time/knowledge to support pwd who find the expected independence in working with technology challenging.
Conclusion: The findings suggest a tension between the growing complexity of care and hcps’ sense of responsibility. This calls for further research and encourages healthcare organizations to consider this when designing care pathways.