“Experiences of Patients With Type 2 Diabetes Starting Insulin Therapy” by Phillips

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Title Relevance

The title is accurate enough since it describes the diagnostic area of focus, the stage at which patients are, and the fact that the study means to be no more than descriptive.

Researcher Qualifications

As a diabetes nurse specialist with the metabolic unit of University Hospitals Coventry and Warwickshire NHS Trust/Holbrooks Health Centre, Coventry Primary Care Trust, Anne Phillips is not only a medical-care practitioner but also a specialist in diabetes. UHC Warwickshire is a new, very large (1,250 bed) hospital with facilities not to be found outside London. Being an NHS facility with 27 operating rooms and, at last count, 250 specialists (NHS, 2008), UHW specialists like Phillips presumably work to high standards of peer review.

Methodology

The author employed the qualitative approach of phenomenology, one of the more rudimentary techniques available for first-time research into a subject area. It is fairly straightforward and easy to learn because it involves merely collecting feedback in unstructured depth interviews and reflecting on the same through the lens of medical praxis.

One inspects the phenomena from different perspectives – in this case, the feedback of patients who have just started on insulin administration – and essentially lets the information take us where it might. There is no working hypothesis as we know it other than the determination to discover as many elements of the condition as one can. Like every other qualitative technique, phenomenology trades scientific rigor for insight (Boeree, 1998). After all, qualitative methods uncover a wide range of insights and examples but have no predictive value.

Idea of Interest

The author sets out to discover how diabetes type 2 patients cope with needing to have insulin administered, now that the syndrome has progressed to the point where oral medication no longer effectively controls blood glucose levels.

Sample Size and Adequacy

The sample comprised just eight patients who had been on insulin therapy for at least a year. While there is no hard and fast rule on what makes for reliability in qualitative research, one is concerned that the author accounted for four patient variables: gender, age, frequency of insulin administration, and the period since starting insulin therapy. To the extent that these classificatory variables are relevant or moderating factors and could have produced some hint of inter-group variation, one would have wished for at least twice or three times that number.

Data Collection/Clarity of Analysis Steps

Interviews took place in privacy to allow patients maximum leeway for expressing their distress or other feelings. To make sure nothing was missed, the author recorded all proceedings. In addition, she made notes of her observations, particularly about non-verbal phenomena, immediately after each interview. Lastly, the transcripts were content-analyzed and coded. This is all painstakingly listed and recommended procedure for qualitative research (Oka and Shaw, 2000).

Discovery and Implications

The author brought to the fore the shock of the initial diagnosis and the concern of patients for at least informing other family members about the disease lest unhealthy habits lead them down the same path.

Prior biases that patients on insulin must be “different” aggravated the shock at learning that they now had to undergo insulin treatment. Fellow-patient group support alleviated their distress somewhat but brusque treatment by physicians and the sinking feeling they were getting due punishment for “neglectful” behavior made the prescription to go on insulin akin to a life sentence.

Once they had started on the course of taking insulin, patients detailed eight other themes of behavior, taking comfort or feeling even more negative about their “deteriorating condition”:

Coping by learning more (but getting dismayed at perceiving that some health care professionals they encountered were not as up-to-date about diabetes) and seeking like company.
Adjusting by adhering to a healthier eating regimen. It would seem going on insulin sharply increased patient compliance.
Taking heart from the apparently active lives and “sporting achievements” of celebrities who had their condition.
Dismay about the awful inefficiency of NHS staff calling for repeated glucose level tests.
Discrimination on the job and on having to forego more privacy when hiring a car, taking out insurance, or renewing their licenses.
Increased concern and hypochondriac-type anxiety that new symptoms they suffer herald a severe hypoglycemic episode. On the other hand, there were patients who reported enhanced quality of life after going on insulin.
Most telling, perhaps, was the guilt feelings and loss of control owing to the inherent difficulty of managing blood glucose levels. Patients believe it is entirely their fault.

Other than suggesting the possibility of a larger-based study, Phillips painted a rosy picture of her findings and foresaw no need for remedial action.

Ethical Considerations

The researcher ensured that participation remained voluntary and implemented every protection that patient privacy demanded (Medical Research Council, 2000/2003). The latter included showing them interview notes and transcripts and obtaining informed consent at varying stages of the process, a point Bartunek and Louis (1996) stress.

Next Step in Research Process

In reality (see point 9 above), this qualitative study by Phillips opens up new avenues for more robust research. Cartwright et al. (2006), for instance, described a large-scale community-based participatory research in the course of which 172 qualitative interviews had already been conducted in Idaho. Such a wider study is called for because the Phillips exploration had revealed opportunities for improving patient management and even embarking on preventive social marketing designed to hold back the onset of second-stage, insulin-dependent type 2 diabetes. The revelation of patient anxieties and mistreatment at the hands of NHS staff are in themselves matters of import.

Brief Evaluation

Philips evidently knows her facts. This is the virtue of having a practicing specialist carry out any kind of writing or research. This helps explain why she writes clearly, albeit her work could have used the services of a style editor to enhance readability and rhetoric.

Such credibility helps explain why the Phillips research needs to be expanded and, if validated by quantitative research, inform health care practitioners about the opportunities they miss both for alleviating the mental state of patients and perhaps even taking cues on stabilizing those who are still on oral medication.

As to the weaknesses, the reportorial style is dry, confined to a recitation of facts and findings, and more reticent than authoritative. Inexperience at research reporting shows in a disorganized review of the literature.

All in all, the study informs the hapless novice and that is perhaps its primary value. After all, phenomenology yields nothing more than a little case experience by nurse specialists or physicians would ordinarily provide. If that is, they have the heart to pay more attention to their patients.

References

Bartunek, J. M. & Louis, M. R. (1996). Insider/outsider team research. Thousand Oaks, CA: Sage.

Boeree, C.G. (1998). Qualitative methods: Part one, phenomenological description. Shippensbrug University. Web.

Cartwright, E., Schow, D., Herrera, S., Lora, Y., Mendez M., Mitchell D., Pedroza, E., Pedroza, L. & Trejo, A., (2006) Using participatory research to build an effective type 2 diabetes intervention: The process of advocacy among female hispanic farmworkers and their families in southeast Idaho. Women and Health, 43(4).

Medical Research Council (2000/2003) Personal information in medical research. Web.

NHS (2008). One of Europe’s top hospital has opened in Coventry. Web.

Oka, T. & Shaw, I. (2000) Qualitative research in social work. Web.

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