Empathy Over the Phone Boosts Diabetes Care

Credit: Adobe Stock/bnenin

Layperson-delivered, empathy-focused phone interventions offered an effective and scalable strategy for improving glycemic control, especially for patients with mental health challenges.

Previous research has demonstrated individuals trained on empathetic connection protocol for telephone-based interactions that prioritized participant interests were able to improve symptoms of depression in just four weeks. Low-income individuals with diabetes may have particular difficulty managing their condition due to emotional distress, mental health struggles and healthcare system constraints.

To evaluate whether empathy-focused phone calls from laypeople can help patients better control their diabetes, investigators conducted a randomized clinical trial from February 2022 to November 2023 that included 260 low-income patients with uncontrolled diabetes from a health center in Austin, Texas. Participants were also asked to complete the 9-item Patient Health Questionnaire (PHQ-9) at baseline, with a cutoff score of 5 indicating subclinical depressive symptoms and emotional issues.

“We hypothesized that sharing the day-to-day aspects of living with diabetes with an empathetic listener could reduce emotional burden, lower barriers to lifestyle changes and improve disease management,” wrote a team of investigators led by Maninder K. Kahlon, Ph.D., associated with Dell Medical School at the University of Texas. “Because depressive symptoms are associated with glycemic control, we balanced depressive risk in the trial arms.”

Patients in the intervention group received empathy-oriented phone calls for six months, while the control group received standard care.

The intervention consisted of calls from a dedicated, trained caller to chat about a patient’s life with diabetes. There were no scripts to follow, and each call had an unlimited duration. Patients received three calls during the first week and then chose to receive between one and five calls per week for the next three weeks, and then one call every one or two weeks. This group also had the option to receive a pedometer or smart scale, were given two gifts selected by their caller, and had the ability to “graduate” from the program.

The primary end point was to compare hemoglobin A1c (HbA1c) levels of each patient from baseline at months three and six and compare these measurements between the intervention and the control cohorts. Other end points included patient-reported self-perceptions of diabetes management, diabetes-related behaviors and distress, and mental health characteristics.

The mean age of participants was 49.5 years, 62.9% were women, and most (86.7%) had an annual income of less than $40,000.

At the six-month follow-up, participants receiving empathetic calls saw a significant reduction in HbA1c levels (from 10.0% to 9.3%), particularly for those with depressive symptoms, compared with minimal change in the control group (from 9.8% to 9.7%). For the subgroup of patients with a PHQ-9 score of greater than or equal to 5 at baseline (38.1%), within-person change in HbA1c was -1.1% for those placed in the intervention group compared with 0.1% for controls. For patients with a PHQ-9 score less than 5 at baseline, the within-person change in HbA1c was -0.4% for participants receiving the empathetic calls compared with -0.2% for controls.

As the goal of the calls was to learn more about the patient and these patients chose the length and frequency of their interactions, they were more likely to express their needs to the trained caller. These patients were in turn supported in connecting back to the health system. Investigators believe this approach may have increased their sense of autonomy and enabled healthier changes that were aligned with their own preferences.

At the end of the study, 91.7% of patients in the intervention group believed that the program was extremely beneficial.

“Identifying how such a workforce might accompany and be coordinated with clinical care could accelerate achieving meaningful outcomes for patients and the health system,” investigators concluded.