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Transcription symbols (Adapted from Jefferson, 2004) Aspects of the relative placement/timing of utterances
Source publication
Objectives
Effective clinical communication is fundamental to tackling overweight and obesity. However, little is known about how weight is discussed in non‐weight‐specific settings where the primary purpose of the interaction concerns clinical matters apparently unrelated to weight. This study explores how mental health clinicians initiate discuss...
Contexts in source publication
Context 1
... 21 instances were transcribed in detail using CA conventions, which represent talk in greater detail than verbatim transcription, so that its subtle nuances are captured and can be analysed (Jefferson, 2004; see Table 1). Recurrent practices of interaction that took place within the 21 instances were identified using CA (Schegloff, 2007;Sidnell, 2013). ...
Citations
... Options to address this include broadening communication skills training clinicians receive to move beyond concepts of implicit and explicit weight bias (acknowledging that this persists in healthcare) (Bombak et al., 2016)), to directly address avoidance as an expression of weight stigma. Teaching could include evidence from conversation analysis which explores choice of language and association with patient acceptance of weight management support (Keemink et al., 2022;Speer and McPhillips, 2018;Tremblett et al., 2022). We posit that 'caring by not offering care' may have wider utility to understand the interactions between clincians and patients in other stigmatised health conditions. ...
Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight.
... However, self-report methods are limited by participants' recall of events and do not capture the precise ways in which clinicians and patients communicate [23,24]. Additionally, previous studies of health behavior communication in medical settings have identified that contextual features, such as prior and subsequent talk in conversation, are relevant to the investigation of effective communication practices [25][26][27][28]. ...
Purpose
To generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines.
Methods
Conversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends.
Results
From 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity.
Conclusions
The continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment.
Implications for Cancer Survivors
If seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.
... Options to address this include broadening communication skills training clinicians receive to move beyond concepts of implicit and explicit weight bias (acknowledging that this persists in healthcare) (Bombak et al., 2016)), to directly address avoidance as an expression of weight stigma. Teaching could include evidence from conversation analysis which explores choice of language and association with patient acceptance of weight management support (Keemink et al., 2022;Speer and McPhillips, 2018;Tremblett et al., 2022). We posit that 'caring by not offering care' may have wider utility to understand the interactions between clincians and patients in other stigmatised health conditions. ...
... The alternative, to be minimally delicate, is less well responded to, and could also reduce patients' ability to pre-emptively close down their weight as a topic for discussion. This reflects Speer and McPhillips (2018) findings, from examining interactions in gender identity clinics, that directly 'announcing' a patient's weight is not well received. ...
Obesity is a major worldwide public health problem. Clinicians are asked to communicate public health messages, including encouraging and supporting weight loss, during consultations with patients living with obesity. However, research shows that talking about weight with patients rarely happens and both parties find it difficult to initiate. Current guidelines on how to have such conversations do not include evidence-based examples of what to say, when to say it and how to avoid causing offence (a key concern for clinicians). To address this gap, we examined 237 audio recorded consultations between clinicians and patients living with obesity in the UK in which weight was discussed opportunistically. Conversation analysis revealed that framing advice as depersonalised generic information was one strategy clinicians used when initiating discussions. This contrasted to clinicians who made advice clearly relevant and personalised to the patient by first appraising their weight. However not all personalised forms of advice worked equally well. Clinicians who spoke delicately when personalising the discussion avoided the types of patient resistance that we found when clinicians were less delicate. More delicate approaches included forecasting upcoming discussion of weight along with delicacy markers in talk (e.g. strategic use of hesitation). Our findings suggest that clinicians should not avoid talking about a patient's weight, but should speak delicately to help maintain good relationships with patients. The findings also demonstrate the need to examine communication practices to develop better and specific guidance for clinicians. Data are in British English.
... U istraživanju koje je provedeno uz upit "Kako započeti razgovor o prekomjernoj tjelesnoj masi" pokazalo se da neznatne promjene terminolo gije mogu uvelike utjecati na daljnje liječenje. 12 Kao i kod drugih bolesti, potrebno je izbjegavati etiketiranje (dijabetičar, hipertoničar), a preporučuje se navođenje osobe na prvom mjestu ("bolesnik" tj. "osoba s preti lošću") umjesto navođenja bolesti na prvom mjestu ("pretila osoba", "pretio bolesnik"). ...
... KruskalWallisov test proveden je za ispitivanje raz lika u stavovima prema ispitivanim pojmovima na ra zini rizika od 1% između pet skupina ispitanika, a napravljen je Dunn posthoc test s Bonferronijevom korekcijom. Analizirajući prihvatljivost nazivlja u zdravstvenom okruženju, najbolje su bili vrjednovani termini "pre tio" (4,97) i "adipozan" (4,67), iza kojih slijedi "debeo" (2,84) i "bucko" (2,12). U nezdravstvenom okruženju poredak je bio identičan -najpoželjniji termini su bili "pretio" (4,85) i "adipozan" (4,51), iza kojih su slijedili "debeo" (3,10) i "bucko" (2,88). ...
Cilj studije: Kod postavljanja dijagnoze debljine izrazito je važna komunikacija liječnika s bolesnikom, jer se i sama terminologija ponekada doživljava uvredljivom. Cilj ove studije bio je iznaći nazivlje kojim bi se naglasila ozbiljnost medicinskog stanja, ali i ono kojim bi se izbjegla nepotrebna nelagoda zbog imenovanja dijagnoze. Ispitanici i metode: u studiju je bilo uključeno 500 ispitanika (bolesnici, liječnici, nutricionisti, studenti medicine i društveno-humanističkih znanosti) koji su odgovorili na upitnik evaluirajući četiri naziva koji opisuju debljinu. Analizirani su njihovi stavovi prema terminu koji im je bio prihvatljiv/uvredljiv u zdravstvenom i u svakodnevnom okruženju. Rezultati: podatci su sakupljeni koristeći online alat SurveyMonkey®. Ispitanici su smatrali nazive ‘pretio’ i ‘adipozan’ prihvatljivima i u zdravstvenom i u svakodnevnom okruženju, a navedeno se najviše odnosi na liječnike i studente medicine. Naziv ‘debeo’ svi su smatrali neprihvatljivim, a najviše nutricionisti. Naziv ‘bucko’ je doživljen kao najviše uvredljiv; zanimljvo je da su ga bolesnici najbolje prihvatili. Zaključak: u dijagnozi debljine terminologiju treba koristiti s oprezom. Imajući u vidu rezultate ove studije, preporučuje se koristiti nazive ‘pretio’ i ‘adipozan’, izbjegavati kolokvijalne nazive, a termin ‘debeo’ koristiti s oprezom.
Aim of the study: Terminology used during diagnosis of obesity is sometimes perceived as insulting, so the proper physician’s communication with the patient is of utmost importance. A study was conducted with the aim to provide a term that would gain consciousness about medical condition and avoid unnecessary discomfort. Subject and methods: A total of 500 participants (patients, physicians, nutritionists, medical students and students of humanities and social sciences) answered the online questionnaire. Four terms describing excess body weight were evaluated. Attitudes towards particular term which they considered as acceptable/insulting in healthcare vs. everyday setting were analyzed. Data were collected using only SurveyMonkey®tool. Results: Participants found terms ‘obese-pretio’ and ‘adipose-adipozan’ acceptable in communication in healthcare and everyday surroundings, mostly by physicians and medical students. Term ‘fat-debeo’ was considered inappropriate, mostly by nutritionists. Term ‘chubby-bucko’ was found the most unacceptable. Surprisingly, it was best accepted by the patients. Conclusion: When diagnosing obesity terminology should be used with caution. Having in mind the results of this study, the recommendation is to use terms ‘obese-pretio’ and ‘adipose-adipozan’, to
avoid colloquial terms, and to be careful when using term ‘fat-debeo’.
... To date, no studies have used CA to assess patient-to-patient interactions; instead, CA research typically focuses on clinicianpatient interactions, addressing issues such as resistance (22) and advice giving (23) CA is often exploited to explore conversations on sensitive topics such as weight management (24) and cancer (25), but has not yet been extended to use in chronic pain. Consequently, the application of CA in a chronic pain setting may prove effective in understanding the conversation sequences and discursive organization presenting in interactions between PLwCP. ...
Objectives:
Social support is most positively perceived when there is an optimal match between a patient's need for communication and the purpose of their interaction. Maladaptive communication patterns may inhibit social bonding or mutual support, negatively impacting clinical outcomes. This study aimed to identify how people with chronic pain naturalistically converse together about their pain in the context of a Pain Management Programme (PMP).
Methods:
Seven participants (4 females; 3 males) with ongoing chronic pain who were attending a PMP in a regional hospital in the United Kingdom were audio/video recorded during breaks in their PMP. Interactions were transcribed using Jeffersonian Transcription and analyzed using Conversation Analysis.
Results:
Two conversational mechanisms were identified: (1) Conversational humor; and (2) A venting cycle. Participants used their pain-related experiences construct a motive for a joke, then proceeded to deliver the joke, which initiated a joke return from observers. The sequence was completed by a collaborative punchline. In the venting cycle, an initial complaint was escalated by the sharing of comparable experiences, after which the vent was concluded through a joke punchline, acting as a pivot to move the conversation forwards, terminating the venting.
Conclusions:
Humorous interpersonal interactions about chronic pain provided a forum for social support-building within the PMP. Humor was affiliative and built social collaboration, helping individuals to together make sense of their pain in a prosocial atmosphere, approaching pain-related experiences with levity. Patient-to-patient interactions within the PMP were strongly prosocial and inclusive, potentially facilitating enhanced PMP clinical outcomes through collaboration.
... Four participants (2 patients and 2 health professionals) could not be contacted within the 4 week timeframe, meaning that 30 interviews were completed (88.2% of the sample). Interviews lasted approximately [35][36][37][38][39][40][41][42][43][44][45] minutes. Four overarching themes emerged from the thematic analysis of the qualitative data. ...
... Similar findings were reported in studies where primary care physicians reported having adequate knowledge and understanding about the health benefits for patients associated with achieving recommended levels of physical activity [41], even though other work has demonstrated that physical activity is less likely to be discussed with patients compared to other modifiable factors, such as smoking or blood pressure [42]. While there is evidence to suggest that brief interventions can be effective in producing small but significant behavioural changes in patients [43], behaviour change conversations around physical activity can be challenging [44,45]. Thus, standardised training may be necessary to provide clinicians with effective, evidence-based skills [46,47]. ...
Background
The important role of primary care in promoting healthy lifestyle behaviours needs informed support.
Aim
To elicit views on a 39-item shared decision-making (SDM) aid (SHARE-D) for lifestyle change and refine it to improve implementation.
Design & setting
Mixed methods study.
Method
Health professionals, patients, and support workers, with experience of managing, or a history of, cardio- or cerebrovascular disease, were purposively recruited based on age, gender, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision-aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically.
Results
Substantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: (i) core content of the decision-aid, (ii) barriers to use, (iii) motivation for lifestyle change, and (iv) primary care implementation. ‘Self-reflective’ questions and goal setting were viewed as essential components. The paper-based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30-item aid was considered suitable for facilitating brief conversations and promoting patient autonomy.
Conclusion
The SHARE-D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in-depth information to support implementation of a refined version. Further studies should examine its effectiveness.
... Moreover, 46% of individuals have initiated discussion themselves [24]. BMI estimation and assessment of individuals' health profile maybe an effective way to start such conversations [33]. Timely interventions may prevent potential complications of obesity. ...
Background
The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts.
Methods
This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population.
Results
Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents’ perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06–2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20–0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36–4.84; p = 0.003) was associated with healthier behavior among participants with obesity.
Conclusion
Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.
... A contributing factor could be that PwO assumed full responsibility, thus highlighting opportunities to adopt new strategies for improved communication between HCPs and PwO. The results from the study also supported the need for improved education concerning the biological basis and clinical management of obesity in Mexico (29), as current approaches can often appear to be outdated and may not contain evidence-based recommendations (19). ...
Objective
The Awareness, Care, and Treatment in Obesity Management–International Observation (ACTION‐IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico.
Methods
An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m² based on self‐reported height and weight. Eligible HCPs had direct patient care.
Results
The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty‐three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight‐loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty‐five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years.
Conclusions
This ACTION‐IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient‐centered approaches.
... Comparing waist circumference to population-specific thresholds and discussing the calculation of BMI with the patient allows both the clinician and patient to agree that the patient is above the healthy weight range without the clinician seeming judgemental. 32 This approach can improve the quality of interactions between patients and clinicians, promoting confidence within the patient to confide in the clinician, thereby allowing the identification of weightrelated issues and treatment options. Even a brief intervention delivered by primary care clinicians providing patients with advice to change behaviour was viewed as appropriate and helpful by patients, prompting most to start taking action to control their weight. ...
With the increasing prevalence of overweight and obesity worldwide, there is a reciprocal increase in the global economic burden and ill‐health from obesity‐related chronic diseases. Primary healthcare services have a role to play in ensuring early detection of weight issues and in directing patients towards evidence‐based care to slow this progression. Research shows that many people with obesity are motivated to lose weight and want their clinician to initiate a conversation about weight management and treatment options. However, this conversation rarely occurs and there is a significant delay in treatment, resulting in an increased burden on the individual, healthcare system and society. In this paper, the components and rationale for the clinical assessment of adult patients with overweight or obesity, including anthropometric measurements and pathology tests, are described. Recommendations to ascertain the potential factors influencing the development of obesity in the patient, such as lifestyle factors (diet and physical activity) and mental health, are also provided. The potential sequelae of obesity that may be present and the necessary assessments for diagnosis are also addressed. These assessments are vital to ensure the patient is referred to the appropriate allied health services and/or specialists.
