Diabetes is a complex chronic disease, one that demands a lifelong process of adjustment and a continual search for different ways of coping.
Individuals may go through shock, denial, anger, sadness, and acceptance, similar to emotions that one would experience during grief and loss.
Patients and their families often report that they are not only dealing with the diagnosis itself but also other health issues, along with mental health, lifestyle and financial concerns, making it particularly difficult to focus on managing diabetes.
“Most people diagnosed with diabetes will likely get all of the support they need from their physician,” says Amanda Karusewicz, Registered Social Worker at the Centre for Complex Diabetes Care (CCDC). “However, 15 percent of people living with diabetes have more complicated health and psychological issues that make it particularly challenging to manage their self-care.”
Psychosocial support services at the CCDC offer assessment, strategies and interventions to assist patients in coping with their life issues in order for them to better manage their health.
As a social worker with the CCDC’s interprofessional team, Karusewicz offers practical support to patients with regards to basic needs such as income, housing, and food security concerns. “When dealing with chronic complex conditions, I think about the acronym CARE: counselling, advocacy, referrals to community supports and education as being key components of the psychosocial support services at CCDC,” says Karusewicz.
Another part of the role of the CCDC’s social supports systems is to help patients break habits and make lifestyle changes. For example, the team’s dietitian offers suggestions to the patient about diet and nutrition, but it may be difficult to break old habits even if the patient is given all of the information.
The team works with patients to set goals to help them self-manage by trying to find ways to make small behavioural changes, such as eating three meals a day, says Sharon Howk-Ventrudo, Psychological Associate (Supervised Practice) at CCDC. “When we’re helping someone set goals, we ask: How important is this to you? How confident are you that you can make the changes?”
These types of questions assist patients with self-efficacy which is the belief that they can be successful in making their identified changes, empowering patients to continue with ongoing self-care.
In some cases, simply developing a goal is the goal. When there is a discrepancy between a patient’s values and goals, Motivational Interviewing is sometimes needed. A team member will discuss and explore with individual patients so they can arrive at a goal on their own.
“The beauty of the interprofessional team is that we work closely together to support clients in their goals,” says Howk-Ventrudo.
Success means something different for everyone. For some clients who have a history of not taking an active interest in their health, success may mean just coming to the CCDC.
Success for others is acknowledging that their health is important.
Research shows that having at least one confidant and feeling supported can improve emotional wellbeing and lower the effects of stress and health risks, says Karusewicz. “If we look at how complex diabetes is, it makes perfect sense that support is essential on all levels which encompasses a holistic approach to providing a patient’s overall care.”