Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
Division of Biostatistics, Mayo Clinic, Rochester, MN, USA.
Patient Educ Couns. 2019 Dec;102(12):2353-2357. doi: 10.1016/j.pec.2019.07.009. Epub 2019 Jul 12.
To determine the potential relationship between measures of patient-provider communication and patient body mass index (BMI) and gender in cancer care.
We audio-recorded cancer patients' communication with their clinicians in an academic medical oncology practice from 2012-2014. We coded audio-recordings with the Roter Interaction Analysis System. We then examined whether BMI was associated with patient centeredness, time with doctor, global affect, and patient self-reported communication quality. Univariate associations with BMI were assessed with Chi-square and Kruskal-Wallis tests. A cumulative logit model adjusted for patient and visit characteristics in a multivariable model.
We recorded 327 patient interactions with 37 clinicians. After adjusting for patient sex, and visit characteristics, visit length, patient-centeredness, global affect (patient or clinician) and satisfaction did not differ. However, higher BMI was associated with shorter visit length, and lower Negative Global Affect (p = 0.03 and p = 0.03, respectively) in men only.
In this exploratory analysis, communication characteristics did not vary by patient BMI overall. However, in men, higher BMI was associated with shorter visit length and more negative affect. Those differences did not persist after adjusting for multiple comparisons.
Patient body size may contribute to clinical communication in cancer care, particularly for obese men.
确定在癌症护理中，医患沟通措施与患者体重指数（BMI）和性别之间的潜在关系。
我们在 2012-2014 年期间，对学术肿瘤医学实践中的癌症患者与临床医生的沟通进行了音频录制。我们使用 Roter 交互分析系统对音频记录进行了编码。然后，我们研究了 BMI 是否与以患者为中心、与医生的交流时间、总体情绪和患者自我报告的沟通质量有关。采用卡方检验和克鲁斯卡尔-沃利斯检验评估 BMI 与各变量的单变量相关性。在多变量模型中，根据患者和就诊特征，使用累积对数模型对 BMI 进行调整。
我们记录了 327 名患者与 37 名临床医生之间的 327 次互动。在调整了患者性别和就诊特征后，就诊时间、以患者为中心、总体情绪（患者或临床医生）和满意度没有差异。然而，男性 BMI 较高与就诊时间较短，以及负性总体情绪（p=0.03 和 p=0.03）较低相关。
在这项探索性分析中，整体上患者 BMI 与沟通特征无差异。然而，在男性中，BMI 较高与就诊时间较短和负性情绪更多相关。这些差异在进行多次比较调整后并未持续存在。
患者体型可能会影响癌症护理中的临床沟通，特别是对肥胖男性。
