Obesity as a Barrier to Patient-Physician Communication

描述(由申请人提供)：肥胖症的流行对美国人的健康构成了严重的风险，因为它导致了糖尿病、高血压以及癌症发病率和死亡率的上升，尽管不太为人所知。医生通过减肥、营养和体力活动咨询在解决肥胖问题上发挥着不可或缺的作用；然而，只有40%的超重或肥胖患者报告接受了此类咨询。我们的多学科调查团队拥有社会心理学、医患沟通和流行病学方面的专业知识，并在检查差异、肥胖和沟通方面有着良好的记录，建议探索患者和医生如何讨论减肥。这项研究的具体目的是确定(1)医生和患者讨论减肥的方式是否会导致超重和肥胖患者的实际减肥；(2)医患之间关于减肥的讨论是否会影响患者的准备、自我效能、结果预期和减肥动机；以及(3)医生在讨论减肥时是否与讨论其他话题时进行了不同的沟通。为了实现这些目标，我们提议对480次患者-医生初级护理会面进行录音(40名在达勒姆社区执业的家庭医学和内科医生；每人12名患者，6名超重患者和6名肥胖患者)。编码员将评估初级保健医生使用以患者为中心的技术或激励性访谈技术作为减肥咨询质量的衡量标准的频率。作为减肥讨论数量的衡量标准，编码员将对患者和医生讨论的内容进行评分(例如，卡路里限制、体力活动、向营养师推荐、处方减肥药等)。除了录音访问的客观指标外，我们还将评估患者在访问三个月后的体重减轻情况，以及他们对访问内容的即时感知、他们与医生的沟通、他们与医生的关系以及减肥的心理社会中介因素(例如，准备好了、自我效能、结果预期和减肥动机)。这项研究的结果将通过检查医生和患者如何讨论减肥来扩大患者与医生沟通的领域；这些信息可以用于开发针对患者和医生的干预措施，以改善与体重相关的沟通，从而帮助遏制肥胖流行。

DESCRIPTION (provided by applicant): The obesity epidemic poses serious health risks for Americans by contributing to rising rates of diabetes, hypertension, and also, although less well known, cancer morbidity and mortality rates. Physicians play an integral role in addressing obesity through weight loss, nutrition, and physical activity counseling; however, only 40 percent of overweight or obese patients report receiving such counseling. Our multidisciplinary team of investigators with expertise in social psychology, patient-physician communication, and epidemiology, and a track record in examining disparities, obesity, and communication proposes to explore how patients and physicians discuss weight loss. "The specific aims of this study are to determine (1) whether the way physicians and patients discuss weight loss leads to actual weight loss among overweight and obese patients; (2) whether patient-physician discussions about weight loss affect patients' readiness, self-efficacy, outcome expectancies, and motivation to lose weight, and (3) whether physicians communicate differently when they discuss weight loss than when they discuss other topics. To accomplish these aims, we propose to audio record 480 patient-physician primary care encounters (40 family medicine and internal medicine physicians practicing in the Durham community; 12 patients each, 6 with overweight and 6 with obese patients). Coders will assess the frequency with which primary care physicians use patient-centered techniques or motivational interviewing techniques as a measure of the quality of the weight loss counseling. As a measure of the quantity of weight loss discussions, coders will rate what patients and physicians discuss (e.g., caloric restriction, physical activity, referral to nutritionists, prescription weight loss medication, etc.). In addition to the objective measures from the audio recorded visits, we will assess patients' weight loss three months after the visit as well as their immediate perceptions of the content of the visit, their physicians' communication, their relationship with their physician, and psychosocial mediators of weight loss (e.g., readiness, self-efficacy, outcome expectancies, and motivation to lose weight). Results of this study will expand the field of patient-physician communication by examining how physicians and patients discuss weight loss; this information can be used to develop interventions targeted toward patients and physicians to improve weight-related communication and thus help curb the obesity epidemic.