How could shared patient experience support the process of decision-making in starting insulin therapy in non-insulin-treated adults with type 2 diabetes in the UK?

Background: Many individuals with type 2 diabetes are reluctant to accept insulin treatment. As a complementary resource to formal support, an intervention based on shared patient experience might be able to facilitate such a process. Presently, however, there are many uncertainties about the evidence to support the pragmatic use of shared patient experience. Methods: Several research techniques were used to examine these issues. A review of existing systematic reviews was conducted to clarify the idea of shared patient experience in a context of type 2 diabetes management in general. Second, a systematic review explored the impact of shared patient experience on health in adults with type 2 diabetes. Third and fourth, two linked studies, a narrative literature review of qualitative studies and a secondary analysis of an existing collection of qualitative interviews examined patients’ attitudes, experiences, information/support needs in relation to the initiation of insulin therapy. Fifth, a primary qualitative study investigated patients’ views and preferences toward the use of shared patient experience to support the process of decision-making in starting insulin. Finally, a proposed intervention design was developed based on all the evidence provided by the previous studies. Results: More new knowledge was contributed to the field of shared patient experience in diabetes care by identifying a working definition of shared patient experience, some common components of shared patient experience and some studies highlighting the evidence of the effects of shared patient experience on disease-related health in type 2 diabetes. It also revealed the patients’ reluctance about moving onto insulin, concerns about the lack of communication about insulin with their healthcare providers prior to insulin, a range of valuable potential shared patient experience has to help patients in the decision-making process, and the patients’ preferences about different formats of shared patient experience. This evidence suggested that shared patient experience, delivered though a face-to-face one-to-one discussion and/or an online curated collection of the filmed narrative interview material conveying certain key elements of peers’ stories, could be an appropriate, efficient and acceptable way to deliver such an intervention in the context of insulin decision-making in type 2 diabetes. Conclusion: There are still many patients being left with psychological concerns about insulin and without sufficient support to overcome such concerns, suggesting a need for additional support which can be delivered as a supplement to formal support provided by healthcare professionals. Shared patient experience could be one of the potential strategies to help ease the process of insulin decision-making.