A cluster randomized trial at a New Haven federally qualified health center tested whether agenda-setting conversation cards, used alongside usual primary care, could improve how well type 2 diabetes treatment fits into patients' daily lives. Patients selected up to three cards covering concerns such as food insecurity, medication costs, or emotional distress to discuss with their clinician. The intervention was designed as a brief, pragmatic tool rather than a comprehensive self-management program.
At six months, the intervention did not significantly improve mean Illness Intrusiveness Ratings Scale scores (32.1 vs 37.1) or HbA1c levels (8.8% vs 9.1%) compared with usual care alone. Treatment burden and diabetes distress scores also showed no significant differences. However, clinicians in the intervention group were far more likely to report satisfaction with visits and confidence in responding to patient concerns, while patient satisfaction remained high in both groups.
The trial did find higher medication adherence and more post-encounter medication adjustments in the intervention group, suggesting the cards may prompt clinicians to act on patient priorities. Commentators praised the intervention for not lengthening visits, but noted that identifying a problem does not necessarily provide the resources to solve it. They called for building clinical and community infrastructure to act on patient priorities, making this an opportunity rather than simply a limitation.