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Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk).

ABSTRACT: OBJECTIVE:We assessed the accuracy and congruence of recall of weight topics during clinical encounters between adolescent patients with overweight/obesity and physicians (randomized to Motivational Interviewing education vs. control arm). METHODS:We audio recorded 357 clinic encounters and coded topics of weight, physical activity (PA), breakfast, and fast food. We assessed recall accuracy/congruence. Generalized estimation equation modeling assessed associations between selected factors and recall accuracy. RESULTS:Accuracy for physicians was: weight (90%), PA (88%), breakfast (77%) and fast food (70%). Patient accuracy was: weight (94%), PA (94%), breakfast (73%) and fast food (61%). Physician/patient congruence was: weight (89%), PA (90%), breakfast (71%) and fast food (67%). Use of a reminder report indicating adolescent's weight behaviors in the physician control group resulted in increased adolescent (p?=?0.02) and physician accuracy (p?=?0.05) for fast food. Adolescents were more likely to recall discussions of fast food (odds ratio, 0.87; 95% CI, 0.77-0.97) as encounter time decreased; male adolescents were less likely to recall breakfast than females (odds ratio, 0.52; 95% CI, 0.28-0.95). CONCLUSION:Adolescents and physicians recall weight and PA more often, perhaps indicating greater engagement in these topics. PRACTICE IMPLICATIONS:Reminder reports might possibly enhance discussion and recall of diet related messages.

SUBMITTER: Bodner ME

PROVIDER: S-EPMC6478386 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk).

Bodner Michael E ME Lyna Pauline P Østbye Truls T Bravender Terrill T Alexander Stewart C SC Tulsky James A JA Lin Pao-Hwa PH Pollak Kathryn I KI

Patient education and counseling 20180726 12

<h4>Objective</h4>We assessed the accuracy and congruence of recall of weight topics during clinical encounters between adolescent patients with overweight/obesity and physicians (randomized to Motivational Interviewing education vs. control arm).<h4>Methods</h4>We audio recorded 357 clinic encounters and coded topics of weight, physical activity (PA), breakfast, and fast food. We assessed recall accuracy/congruence. Generalized estimation equation modeling assessed associations between selected ...[more]

PMID: 30115415

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Project description:BACKGROUND:Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. OBJECTIVE:To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. DESIGN:Cross-sectional survey nested within a randomized CHD prevention study. SETTING AND PARTICIPANTS:University internal medicine clinic; 24 physicians and 157 patients. METHODS:Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives. RESULTS:Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making. CONCLUSIONS:Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.

Project description:Background: The Ostrobothnia Depression Programme (ODP) in Finland was intended to implement two evidence-based brief psychotherapy interventions, namely motivational interview and behavioural activation, in several regional psychiatric teams. A simultaneous effectiveness study was conducted. Considerable tension was encountered between these two arms, causing resistance to change. We conducted a qualitative case study to better understand this tension and to discuss how managerial and executive practices may ensure the successful running of a hybrid design programme.Methods: We conducted focus group interviews to evaluate the phases of preparation and practical execution of the ODP from the perspectives of management and the programme executives. To gather the data, we applied the revised Socratic approach for health technology assessment and focus group interviews. We analysed the data deductively according to the Normalization Process Theory.Results: We identified two main critical issues: (1) The ODP programme plan ignored the team leaders' crucial role in influencing the implementation climate and mobilizing organizational strategies. The ODP had a simplistic top-down design with minimal and delayed collaboration with its target groups in the preparation phase. (2) Incongruence occurred between what the project group had explicitly communicated about being the spearhead of the ODP and what they then actually enacted. These two issues caused tension between the implementation efforts and the effectiveness study as well as resistance to change among the staff.Conclusion: Early, open collaboration with all prospective stakeholders towards a shared understanding about the programme is the first action the programme administrators should take. Agreement on goals and the means to achieve them would lower tension between the two arms of a hybrid design programme, thereby reducing resistance to change. Congruence between the goals communicated and the actual managerial and executive actions is of paramount importance in getting the programme recipients on board.

Project description:Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality.To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents.Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area.Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ? 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ? 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR]?= 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation.Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making.clinicaltrials.gov Identifier: NCT01040975.

Dataset Information

Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk).

Publications

Accuracy and congruence of physician and adolescent patient weight-related discussions: Teen CHAT (Communicating health: Analyzing talk).

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