The Impact of Patient Obesity on Patient-Centered Quality of Care

DESCRIPTION (provided by applicant): The proposed study is part of a research and training plan that will enable Dr. Sean Phelan to reach his goal of improving health care quality and disease outcomes for obese individuals by identifying and eliminating barriers to high-quality health care. One such barrier that may negatively affect the quality and content of communication with obese patients is bias or prejudice against obese people. Obesity bias is pervasive in both public and health care provider populations. The implications of high levels of bias in medical students and other health care providers are not known; however, there is considerable evidence that bias against a social group negatively impacts behavior toward members of that group. Health care provider bias against stigmatized groups may contribute to disparities in patient-centered care and provider decision-making. The direct impact of implicit and explicit bias against obese patients on provider behavior has not been investigated. This represents a significant gap in our knowledge of how patient obesity influences quality of care. Potential areas of behavior in the clinical encounter that may be negatively influenced by obesity bias include (i) patient-centered communication, which predicts better patient outcomes, satisfaction, and adherence; and (ii) initiation of discussion of health behavior changes, a practice consistent with clinical guidelines. The specific aims of this study are to 1) evaluate th association between advanced medical students' implicit and explicit obesity bias and their patient-centered communication in treatment encounters with obese standardized patients; and 2) evaluate the association between advanced medical students' implicit and explicit obesity bias and clinical decision-making in treating obese patients. Validated interaction analysis strategies will be applied to videotaped encounters between medical students and obese standardized patients in order to measure patient-centered communication and decision-making. A survey will be used to assess implicit and explicit obesity bias and other attitudes in order to achieve the aims of this study. This proposal includes a comprehensive training plan that combines didactic learning with collaborative research experiences. Mentors for this project are productive researchers with expertise in obesity bias, patient- centered communication, and the role of provider bias in health disparities. This research and training plan will take place inan extremely supportive research environment at the Department of Family Medicine at the University of Minnesota Medical School.