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Research ArticleOriginal Research

Accuracy and Congruence of Patient and Physician Weight-Related Discussions: From Project CHAT (Communicating Health: Analyzing Talk)

Michael E. Bodner, Rowena J. Dolor, Truls Ǿstbye, Pauline Lyna, Stewart C. Alexander, James A. Tulsky and Kathryn I. Pollak
The Journal of the American Board of Family Medicine January 2014, 27 (1) 70-77; DOI: https://doi.org/10.3122/jabfm.2014.01.130110
Michael E. Bodner
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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Rowena J. Dolor
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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Truls Ǿstbye
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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Pauline Lyna
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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Stewart C. Alexander
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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James A. Tulsky
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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Kathryn I. Pollak
the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC (MEB, PL, KIP); the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada (MEB); the Durham VA Medical Center, Center for Health Services Research, Durham, NC (RJD, SCA, JAT); the Departments of Medicine (RJD, SCA, JAT) and Community and Family Medicine (TǾ, KIP), Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore (TǾ).
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    Figure 1.

    Patient recruitment flowchart.

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    Table 1. Patient, Physician, and Visit Characteristics
    Patient factors (n = 461)
        Race
            White/Asian66%
            Black35%
        Female sex66%
        Obese (BMI >30 kg/m2)54%
    Physician factors (n = 40)
        Race
            White/Asian/Pacific Islander85%
            Black15%
        Female sex60%
    Visit factors
        Race concordance (dyads)
            White physician/white patient*61%
            White physician/black patient23%
            Black physician/white patient4%
            Black physician/black patient12%
        Type of visit
            Preventive care28%
            Chronic care63%
            Preventive and chronic care7%
            Not reported2%
    • ↵* For race concordance dyads, whites and Asians/Pacific Islanders were categorized as “white” (only 2 patients and 1 physician reported their ethnicity as Asian, and 2 physicians reported their ethnicity as Asian/Pacific Islander).

    • BMI, body mass index.

    • View popup
    Table 2. Accuracy and Congruence of Physician and Patient Self-Report
    Accuracy*
        Overall (n = 461)
            Physician70%
            Patient67%
        When weight was discussed (n = 320)
            Physician97%
            Patient98%
        When weight not discussed (n = 141)
            Physician44%
            Patient36%
    Congruence†
        Overall (n = 461)62%
        When weight was discussed (n = 320)95%
        When weight was not discussed (n = 141)28%
    • ↵* Accuracy: Physicians or patients were accurate if they correctly reported that weight was/was not discussed and verified by audiorecording.

    • ↵† Congruence: Both patient and physician were accurate if they correctly reported that weight was/was not discussed and verified by audio recording.

    • View popup
    Table 3. Probability of Patient Report of a Weight-Related Discussion That Was Not Verified by the Audio Recording
    VariableOdds Ratio (95% CI)P Value
    Physician race
        Black4.35 (0.69–27.28).12
        White1.00
    Education
        More than high school1.43 (0.69–2.93).33
        High school or less1.00
    Patient sex
        Male1.79 (0.91–3.52).09
        Female1.00
    Time spent with patient (minutes)
        One-unit increase1.03 (0.98–1.08).21
    • Patient age and motivation to lose weight were not significant at the univariate level (P > .50) and were not included the model.

    • CI, confidence interval.

    • View popup
    Table 4. Probability of Physician Report of a Weight-Related Discussion That Was Not Verified by the Audio Recording
    VariableOdds Ratio (95% CI)P Value
    Patient BMI
        Obese1.61 (0.87–3.01).14
        Overweight1.00
    Physician comfortable discussing weight
        Mostly to not at all4.50 (1.88–10.75)<.001
        Very comfortable1.00
    Race concordance
        Black patient and white physician0.30 (0.13–0.69).005
        White patient and white physician1.00
        White patient and black physician0.27 (0.01–6.98).43
        White patient and white physician1.00
        Black patient and black physician2.03 (0.36–12.62).45
        White patient and white physician1.00
    Time spent with patients (minutes)
        One-unit increase1.06 (1.00–1.11).053
    • Sex was not significant at the univariate level (P > .50) and was not included in the model.

    • BMI, body mass index; CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 27 (1)
The Journal of the American Board of Family Medicine
Vol. 27, Issue 1
January-February 2014
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Accuracy and Congruence of Patient and Physician Weight-Related Discussions: From Project CHAT (Communicating Health: Analyzing Talk)
Michael E. Bodner, Rowena J. Dolor, Truls Ǿstbye, Pauline Lyna, Stewart C. Alexander, James A. Tulsky, Kathryn I. Pollak
The Journal of the American Board of Family Medicine Jan 2014, 27 (1) 70-77; DOI: 10.3122/jabfm.2014.01.130110

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Accuracy and Congruence of Patient and Physician Weight-Related Discussions: From Project CHAT (Communicating Health: Analyzing Talk)
Michael E. Bodner, Rowena J. Dolor, Truls Ǿstbye, Pauline Lyna, Stewart C. Alexander, James A. Tulsky, Kathryn I. Pollak
The Journal of the American Board of Family Medicine Jan 2014, 27 (1) 70-77; DOI: 10.3122/jabfm.2014.01.130110
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