RT Journal Article
SR Electronic
T1 Accuracy and Congruence of Patient and Physician Weight-Related Discussions: From Project CHAT (Communicating Health: Analyzing Talk)
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 70
OP 77
DO 10.3122/jabfm.2014.01.130110
VO 27
IS 1
A1 Bodner, Michael E.
A1 Dolor, Rowena J.
A1 Ǿstbye, Truls
A1 Lyna, Pauline
A1 Alexander, Stewart C.
A1 Tulsky, James A.
A1 Pollak, Kathryn I.
YR 2014
UL http://www.jabfm.org/content/27/1/70.abstract
AB Objective: Primary care providers should counsel overweight patients to lose weight. Rates of self-reported, weight-related counseling vary, perhaps because of self-report bias. We assessed the accuracy and congruence of weight-related discussions among patients and physicians during audio-recorded encounters. Methods: We audio-recorded encounters between physicians (n = 40) and their overweight/obese patients (n = 461) at 5 community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results: Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters containing weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%), but when weight was not discussed, patients and physicians were more inaccurate and incongruent (patients, 36%; physicians, 44%; 28% congruence). Physicians who were less comfortable discussing weight were more likely to misreport that weight was discussed (odds ratio, 4.5; 95% confidence interval, 1.88–10.75). White physicians with African American patients were more likely to report accurately no discussion about weight than white physicians with white patients (odds ratio, 0.30; 95% confidence interval, 0.13–0.69). Conclusion: Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed but not when recordings indicated no weight discussions. Physicians' overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions.