DPN HCP Survey
Current Estimated Length: 10 minutes.
Thank you for participating in this survey about diabetes. It will take about 10 minutes for you to
complete. To ensure that we ask only questions that are most appropriate for you, please first answer a
few questions about yourself.
[SCREENING AND PATIENT BASE]
1.
Are you a:





2.
Medical Doctor
Registered Nurse
Nurse Practitioner/Advance Practice Nurse
Physician’s Assistant
Other
TERMINATE
What is your primary medical specialty?







QUOTAS
Family or General Practice
Internal Medicine
Endocrinology
Neurology
Pain Medicine, including PM&R and Physiatry
Podiatry
Other
TERMINATE
n=400 MDs, as follows:
n=250 Family, General Practice, or Internal Medicine
n=37 Endocrinology
n=37 Podiatrists
n=38 Neurology
n=38 Pain Medicine
n=100 RNs/NPs/APNs/Pas, as follows:
n=30 RNs
n=35 NPs/APNs
n=35 Pas
3.
Approximately what percentage of your working day is devoted to clinical practice?
_____ %
TERMINATE IF LESS THAN 50%
4.
How many patients with diabetes do you see in a typical month?






Fewer than 1 a month
1–5 patients
6-10 patients
11-20 patients
21-50 patients
More than 50 patients
TERMINATE
QUOTA MAX 100
The rest of the survey will ask you specifically about diabetes, and also about diabetic peripheral
neuropathy, which is referred to in this survey as DPN.
5.
Approximately what percentage of your diabetes patients experience any type of DPN
symptoms in their feet, hands, arms or legs, including:
─ Burning or feelings of heat
─ Electric shock-like feelings
─ Extreme sensitivity to touch, even light touches
─ Numbness, tingling, or unable to feel things
─ Prickling or pins and needles
─ Shooting pain or sharp jabbing
─ Stinging or throbbing
_____% of my diabetes patients [TERMINATE IF 0%]
6.
Of those patients, approximately what percentage experience painful DPN symptoms?
_____% of my DPN patients experience painful symptoms
[CONVERSATIONS WITH PATIENTS]
7.
Please think about all your patients who experience any type of DPN symptom and all your
appointments with them for diabetes care. How often do you discuss each of the following?
SHOW GRID. RANDOMIZE ROWS, BUT ALWAYS KEEP G AND H TOGETHER IN THAT ORDER.
Rarely or never Fewer than half of
Half of
Most
Every
appointments
appointments
appointments
appointment
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Blood sugar (glucose) levels
Eating habits and diet
Exercise and lifestyle
Eye and potential vision problems
Heart, lungs, and potential cardiovascular problems including high blood pressure
Medications for diabetes
Their DPN symptoms
How DPN symptoms interfere with daily activities
Foot related issues
Potential nerve damage
The emotional toll of having diabetes
Kidney function and the potential for problems
8.
Thinking about discussions with patients about DPN symptoms, which of the following best
describes a typical discussion?
 The symptoms are mentioned in passing, but not really discussed
 The symptoms are discussed briefly before moving on to other issues
 The symptoms are discussed in detail
9.
In the last 10 discussions you had with diabetes patients about DPN symptoms, how many
times:
Did you initiate the discussion
Was the patient the first to bring up symptoms
10.
_____ times
_____ times
TOTAL 10
Which of the following statements describes you better?
 Given all the important issues that need to be addressed during a patient visit for diabetes
care, I often rely on my patients to bring up DPN symptoms if needed
 I usually ask patients about DPN symptoms, even if they do not talk about them
11.
How much do you agree or disagree with each of the following statements?
SHOW GRID. RANDOMIZE ROWS.
Disagree strongly
Disagree somewhat
Agree somewhat
Agree strongly
a.
b.
c.
d.
e.
f.
Patients tend to ignore DPN symptoms at first
It can be difficult for patients to describe their DPN symptoms to me
Patients are sometimes reluctant to talk with me about their DPN symptoms
Patients can alleviate DPN symptoms by keeping blood sugar levels down
Patients can reverse DPN by keeping blood sugar levels down
For some patients DPN symptoms are more of an annoyance than a serious health
impairment that requires specific treatment
g. It is important for me to know how DPN affects my patients’ daily lives
h. It is my responsibility to help patients manage their DPN symptoms
i. Diagnosing DPN is relatively easy
j. There is no way to make a certain DPN diagnosis
12.
[IF AGREE ANNOYANCE] For approximately what percentage of patients with any DPN
symptoms would you say that symptoms are more of an annoyance than a serious health
impairment that requires specific treatment?
_____%
13.
Approximately what percentage of diabetes patients with any type of DPN symptoms would you
say suffer limitations in their daily activities (including walking, driving, working, exercising, or
sleeping) because of their symptoms?
_____%
[DIAGNOSIS AND TREATMENT]
14.
What other causes do you often see or suspect are related to diabetic patients’ symptoms of
burning, shooting, or pins and needles in their feet, hands, arms, or legs?
Select all that apply
RANDOMIZE LIST
 Aging
 Arthritis
 Weight
 Poor circulation
 Sciatic nerve dysfunction
 Fibromyalgia
 An injury, either recent or old
 Medication side effects
 Other
 None
15.
When it comes to the latest information, research and guidelines on DPN, which of the following
categories describe you best?
SHOW GRID. RANDOMIZE ROWS.
I would need to learn
I know something
more about this to
about this but
advise a patient
appreciate learning
more
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
I have strong
expertise in this
What causes DPN
The link between diabetes and DPN
How DPN causes pain or numbness
The difference between nerve pain vs. other types of musculoskeletal pain
Ways to stop DPN from progressing
Ways to alleviate the pain of DPN
When medication for DPN pain can be effective
Medications approved by the FDA for DPN pain
Non-medication strategies for managing DPN pain
How to diagnose DPN
How DPN affects patients’ daily activities
16.
Of all your patients who experience any type of DPN symptoms, for what percentage have you:
a. Had them complete a DPN assessment questionnaire
b. Performed specific DPN diagnostic tests, such as a monofilament test
17.
_____%
_____%
Of all your patients who experience any type of DPN symptoms, for what percentage do you
perform a routine foot exam at every visit
_____%
18.
If a patient is experiencing painful DPN symptoms, which of the following do you typically
recommend to manage pain?
Select all that apply
DO NOT RANDOMIZE
 Lifestyle adjustments, such as more exercise, wearing more comfortable shoes, etc.
 More effort to control blood sugar levels
 OTC pain medications
 Prescription medications approved by the FDA to treat DPN pain
 Psychosocial interventions, such as biofeedback, hypnosis, relaxed breathing, etc.
 Physical rehabilitation, such as exercise, massage, etc.
 Alternative therapies such as acupuncture, herbal supplements, Alpha-lipoic acid, etc.
 Injection and infusion therapies
 Implantable devices and surgical interventions
 Other
 None
19.
How likely are you to prescribe medications for DPN pain in each of the following scenarios
where a patient describes symptoms in feet or hands? [IF RN, USE ALTERNATE WORDING: How
likely are you to recommend medications for DPN pain in each of the following scenarios where
a patient describes symptoms in feet or hands?]
SHOW GRID. DO NOT RANDOMIZE ROWS.
Not at all likely
Not too likely
Somewhat likely
a.
b.
c.
d.
e.
f.
g.
h.
i.
Very likely
If patient describes pins and needles
If patient describes burning
If patient describes pain that interferes with sleep
If patient describes pain that hinders walking
If patient describes pain, but does not describe significant impairment of daily activities
If patient describes pain, and also describes significant impairment of daily activities
If patients asks about medications for DPN pain
If patient has expressed concerns about taking too many medications
If patient says pain is happening frequently
20.
Research shows that some patients with DPN:



Have difficulty describing their symptoms and/or pain
Do not understand the difference between nerve pain and musculoskeletal pain
Avoiding raising issues of DPN symptoms or pain, for a number a reasons
If you were helping to train an inexperienced healthcare practitioner, what would you tell him
or her to “listen for” regarding potential DPN?
In other words, what kinds of less-direct things might patients be describing, and what words
or phrases might patients use, that would be clues to potential DPN issues?
Please list three:
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________