title: Accuracy and congruence of patient and physician weight-related discussions: from project CHAT (Communicating Health: Analyzing Talk).
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: the Cancer Prevention, Detection and Control Research Program, Duke Cancer Institute, Durham, NC; the School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada; the Durham VA Medical Center, Center for Health Services Research, Durham, NC; the Departments of Medicine and Community and Family Medicine, Duke University Medical Center, Durham, NC; and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bodner
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: Truls
authors.initials: T
authors.lastname: Ostbye
authors.forename: Pauline
authors.initials: P
authors.lastname: Lyna
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards; D010820:Physicians / Q000592:standards; D011320:Primary Health Care; D015431:Weight Loss
keywords: Communication; Community Medicine; Obesity; Physician-Patient Relations