Developing Empathy for Patients with Chronic Health Conditions: the Diabetes Challenge Kira Zwygart, MD, Kathy Bradley- Klug, PhD, NCSP, Emily Shaffer- Hudkins, PhD, Sara Hinojosa, MA

Disclosures This program was funded by a grant “Bringing Science Home” from the Patterson Foundation Focus on patient centered care, specifically for patients with chronic health conditions

The Diabetes Challenge Simulation Presentation to medical students covering Patient-Centered Care and the Disease Course Model. Bringing Science Home took a team approach to give students a first person look at: Teens with diabetes, Young Adults with diabetes, and Caregivers of people with diabetes. After an opening presentation, two people lead each of the small group discussions (patients and BSH staff).

Life challenges “And I would buy just things that I was not allowed to eat, and that is where all my eating problems started coming from – my attitude towards food is weird, because things were prohibited from me.” “But in college, I guess, I didn’t always come out to all my professors…like I would just take it on myself and like push through it. And so, there’s a good chance that some of my exam grades suffered.” “I brought in all my medical supplies. He [my college roommate] thought I was bringing in like heroin.” “My siblings defend me if someone is talking about me.”

How Diabetes Really Works The concluding group discussion covered everything from nutrition, to multi- drug therapy, to service animals and special accommodations. Medical students and school psychology graduate students were then challenged by the BSH team to live for 24 hours with diabetes.

The 24-Hour BSH Diabetes Challenge During the challenge, students learned: How to use glucose meters How to operate lancing devices When glucose testing occurs in a typical day for a diabetic Carbohydrate counting and insulin ratio mathematics And they participated in a 24-hour text-a-thon that simulates life with diabetes.

Sample Text Messages in The Challenge Before leaving home, make sure to grab blood meter, insulin injection tools, and emergency glucose supplies. Constant preparation is necessary. Your Mom just called. She wants to know your blood sugar. You are 22 and that is annoying. But mom is scared. Your evening with your significant someone is getting intimate. You have diabetes. What should you think about? You do still have to check your BG. Your pump site got wrapped around you overnight. You are high and can't figure out why. Could your site be the problem?

Diabetes Simulation Reflection Prompt Your Diabetes Challenge is over. If you live with Type 1 Diabetes these challenges are never ‘over’. Please reflect on your experiences.

Wrap-up of type 1 diabetes simulation Reactions to the Experience

Themes from Participants in Diabetes Challenge Simulation Food Choices/Regulation –“That was the most eye-opening part of this experience. I make all of my decisions based upon craving, what’s in the pantry, what I have the time to cook, etc. I have a newfound respect for what diabetics must go through every day when they need to be careful about everything they choose to eat.” Medication –“Not only do Type I Diabetics have to take medication daily, they deal with a fluctuating regimen based on what’s currently working, not working or what they can afford.” Pain or discomfort – “It was a hassle to carry around the device everywhere I went and also was somewhat embarrassing/unsanitary to do it in the public.”

Themes from Participants in Diabetes Challenge Simulation Embarrassment –“I also found it difficult to tell some of my friends I was sitting with in class what I was doing. I felt isolated and didn't want to prick my finger in public.” Interpersonal Relationships –“Diabetes just doesn’t affect the person with the disease but everyone else around this person and has the potential to alter relationships and family dynamics.”

Themes from Participants in Diabetes Challenge Simulation Education –“I think there is a growing need for both patient and provider education on the subject. More specifically, education that goes deeper than just the surface of the disease.” Increased confidence or skills –“I feel like I can better talk to patients dealing with chronic illnesses and hopefully help them find ways to make their lives easier or at least be there to listen to their troubles and concerns.”

Future Directions Involvement of other disciplines in the learning activity –Pharmacy students –School Psychologist students Introduce other “challenge” activities –Wheelchair