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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC. Discussing diet, nutrition, and body weight after treatment for gynecological cancer: a conversation analytic study of outpatient consultations. J Cancer Surviv 2024; 18:1016-1031. [PMID: 36897546 PMCID: PMC11081991 DOI: 10.1007/s11764-023-01345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth A Johnston
- Cancer Council Queensland, Fortitude Valley, Brisbane, QLD, Australia.
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia.
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia.
| | - Stuart Ekberg
- Faculty of Health, School of Psychology and Counselling, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
| | - Bronwyn Jennings
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Nisha Jagasia
- Department of Gynaecological Oncology, Mater Hospital Brisbane, South Brisbane, QLD, Australia
| | - Jolieke C van der Pols
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, QLD, Australia
- QIMR Berghofer Medical Research Institute, Population Health Program, Herston, QLD, Australia
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Hajizadeh A, Heath L, Ahmad A, Kebbe M, Jebb SA, Aveyard P, Hughes G. Clinician resistance to broaching the topic of weight in primary care: Digging deeper into weight management using strong structuration theory. Soc Sci Med 2023; 329:115997. [PMID: 37327596 DOI: 10.1016/j.socscimed.2023.115997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/06/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Laura Heath
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Aryati Ahmad
- School of Nutrition and Dietetics, Universiti Sultan Zainal Abidin, Kampung Gong Badak, 21300, Terengganu, Malaysia.
| | - Maryam Kebbe
- Pennington Biomedical Research Centre, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States.
| | - Susan Anne Jebb
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Paul Aveyard
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Gemma Hughes
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
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Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. Talking delicately: Providing opportunistic weight loss advice to people living with obesity. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531292 PMCID: PMC9748302 DOI: 10.1016/j.ssmqr.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Helena Webb
- School of Computer Science, University of Nottingham, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Elizabeth Stokoe
- Discourse and Rhetoric Group, Loughborough University, Loughborough, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Rodrigues LS, Pizato N, Carvalho KMB, Dutra ES, Botelho PB, Andrade LS, Moraes VD, Gonçalves VSS. Validation of a dietary advice protocol for adults with obesity in primary health care according to the Brazilian Dietary Guidelines. Fam Pract 2022:cmac132. [PMID: 36416351 DOI: 10.1093/fampra/cmac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obesity is a non-communicable chronic disease which carries a high cost for the Brazilian Unified Health System. Standardized protocols can help primary health care (PHC) professionals manage the disease. OBJECTIVES To describe the validation process of a protocol concerning dietary guidelines for adults with obesity in PHC by non-nutrition professionals. METHODS A validation study of a dietary advice protocol consisting of 6 recommendations was conducted according to Brazilian Dietary Guidelines. The topics incorporated into the recommendations were submitted to a panel of judges for content validity and achieved a Scale Content Validity Index (S-CVI) score >0.80. Subsequently, an online workshop was held and consisted of guiding questions to adequately improve current protocols. Face validity was assessed in a mediation workshop conducted with PHC non-nutrition professionals. Following the validation process, necessary adjustments were made to the eating protocol. RESULTS The validation process was conducted by a panel of 20 judges and 10 PHC professionals. The content was validated using a 0.98 S-CVI. The online workshop expert panel agreed the instrument provides a trustworthy foundation for appropriate dietary guidelines. Moreover, the judges suggested changes to the flowchart designed to support the professionals' decisions, discussed the absence of quantitative prescription guidelines, and offered additional suggestions to strengthen equity and encourage autonomy in non-nutrition healthcare professionals in PHC. CONCLUSION This study describes the validation process of a dietary advice protocol for people with obesity, as well as the importance of its integration into PHC.
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Affiliation(s)
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Kenia M B Carvalho
- Graduate Program in Public Health, University of Brasilia, Brasilia, Brazil
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Eliane S Dutra
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Patrícia B Botelho
- Graduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | - Laila S Andrade
- Nutrition and Health Research Group-PENSA/UnB, University of Brasilia, Brasilia, Brazil
| | - Verena D Moraes
- Laboratory of Regional Endemic Situations, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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McHale CT, Laidlaw AH, Cecil JE. Predictors of weight discussion in primary care consultations: A multilevel modeling approach. PATIENT EDUCATION AND COUNSELING 2022; 105:502-511. [PMID: 34253384 DOI: 10.1016/j.pec.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. METHODS Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. RESULTS Weight-related discussions were more likely to occur when a greater proportion of PCP's total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. CONCLUSION This work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. PRACTICE IMPLICATIONS Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.
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Affiliation(s)
- Calum T McHale
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Anita H Laidlaw
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joanne E Cecil
- School of Medicine, University of St Andrews, St Andrews, UK
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Pollak KI, Finset A. Weighing the pros and cons of clinicians talking to their patients about weight. PATIENT EDUCATION AND COUNSELING 2022; 105:495-496. [PMID: 35181178 DOI: 10.1016/j.pec.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Kathryn I Pollak
- Duke University, Department of Population Health Sciences and Duke Cancer Institute, Patient Education and Counseling, USA.
| | - Arnstein Finset
- Duke University, Department of Population Health Sciences and Duke Cancer Institute, Patient Education and Counseling, USA.
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McHale CT, Laidlaw AH, Cecil JE. Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study. BMJ Open 2020; 10:e034023. [PMID: 32156764 PMCID: PMC7064140 DOI: 10.1136/bmjopen-2019-034023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland. SETTING Seven National Health Service (NHS) Scotland primary care centres. PARTICIPANTS A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated. DESIGN AND METHODOLOGY A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives. RESULTS (1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors. CONCLUSIONS Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.
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Affiliation(s)
- Calum T McHale
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Anita H Laidlaw
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Joanne E Cecil
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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