Obesity as a Barrier to Patient-Physician Communication

描述（由申请人提供）：肥胖症的流行给美国人带来了严重的健康风险，导致糖尿病、高血压的发病率上升，而且，尽管鲜为人知，癌症的发病率和死亡率也在上升。医生在通过减肥、营养和体育活动咨询来解决肥胖问题方面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这样的咨询。我们的多学科研究团队具有社会心理学、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，旨在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体重减轻；(2)医患之间关于减肥的讨论是否会影响患者的准备度、自我效能感、结果预期和减肥动机；(3)医生在讨论减肥时的沟通方式是否与讨论其他话题时不同。为了实现这些目标，我们建议录音记录480名患者与医生的初级保健接触（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，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动机访谈技术的频率，以衡量减肥咨询的质量。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，热量限制、体育活动、向营养学家的转诊、处方减肥药物等）。除了来自录音访问的客观测量之外，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直接感知，医生的沟通，他们与医生的关系，以及减肥的心理社会中介（例如，准备，自我效能，结果预期和减肥动机）。本研究的结果将通过检查医生和患者如何讨论减肥来扩大医患沟通领域；这些信息可以用来制定针对患者和医生的干预措施，以改善与体重有关的沟通，从而帮助遏制肥胖的流行。

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.