Treating obese patients - what influences our clinical decisions?

Toni McAloon, Donna Fitzsimons, Vivien Coates

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Background: The obesity pandemic is resulting in premature mortality and increased morbidity and healthcare costs. Prevention is a global health priority but effective management for established obesity is also important. It is known that clinicians often have anti-fat attitudes and assumed that this adversely affects care (Puhl et al 2009). However there is a paucity of research linking anti-fat attitudes to clinical behaviour. Aims: to assess the attitudes of multidisciplinary clinicians to obese individuals and identify variables influencing decision-making.Methods: Online vignettes were generated via a Factorial Survey Design method to assess clinical decision making and were combined with the obesity Implicit Association Test (IAT) to assess subconscious anti-fat bias. Data were collected anonymously from a voluntary convenience sample during 2011-2012 in a virtual research lab managed by Project Implicit®. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to registered nurses and students, medical doctors and students, dieticians and students. Participants used a hyperlink to self-administer eight randomly generated unique vignettes with integrated patient photographs, a demographic questionnaire and the IAT. Vignette responses (n = 3,416) were analysed using Multivariate Regression and the questionnaires by descriptive statistics. The IAT score was calculated from the standardised differences in mean response times on 2 key IAT conditions (Greenwald et al 2003). Results: 427 clinicians participated, 79% being female. Disciplines represented were nurses (38%), student nurses (14%), doctors (19%), medical students (20%), dieticians (7%) and dietetic students (2%). Preliminary vignette analysis identified patient and clinician variables influencing motivation to treat, likelihood of addressing weight, and time with the patient The mean IAT score was 0.6854 (95% confidence Intervals 0.6399-0.7309) indicating a strong anti-fat bias.Discussion & conclusion: Our study suggests there may be both patient and clinician variables that impact on effective treatment interventions for clinical management of obese patients.
LanguageEnglish
Title of host publicationUnknown Host Publication
Number of pages17
Publication statusPublished - 22 Mar 2013
EventRCN International Nursing Research Conference - Belfast
Duration: 22 Mar 2013 → …

Conference

ConferenceRCN International Nursing Research Conference
Period22/03/13 → …

Fingerprint

Fats
Students
Nutritionists
Obesity
Nurses
Medical Students
Health Priorities
Premature Mortality
Dietetics
Pandemics
Research
Health Care Costs
Reaction Time
Motivation
Decision Making
Demography
Confidence Intervals
Morbidity
Weights and Measures
Health

Keywords

  • obesity
  • clinical decision making
  • attitudes
  • Factorial Survey Design
  • IAT

Cite this

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title = "Treating obese patients - what influences our clinical decisions?",
abstract = "Background: The obesity pandemic is resulting in premature mortality and increased morbidity and healthcare costs. Prevention is a global health priority but effective management for established obesity is also important. It is known that clinicians often have anti-fat attitudes and assumed that this adversely affects care (Puhl et al 2009). However there is a paucity of research linking anti-fat attitudes to clinical behaviour. Aims: to assess the attitudes of multidisciplinary clinicians to obese individuals and identify variables influencing decision-making.Methods: Online vignettes were generated via a Factorial Survey Design method to assess clinical decision making and were combined with the obesity Implicit Association Test (IAT) to assess subconscious anti-fat bias. Data were collected anonymously from a voluntary convenience sample during 2011-2012 in a virtual research lab managed by Project Implicit{\circledR}. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to registered nurses and students, medical doctors and students, dieticians and students. Participants used a hyperlink to self-administer eight randomly generated unique vignettes with integrated patient photographs, a demographic questionnaire and the IAT. Vignette responses (n = 3,416) were analysed using Multivariate Regression and the questionnaires by descriptive statistics. The IAT score was calculated from the standardised differences in mean response times on 2 key IAT conditions (Greenwald et al 2003). Results: 427 clinicians participated, 79{\%} being female. Disciplines represented were nurses (38{\%}), student nurses (14{\%}), doctors (19{\%}), medical students (20{\%}), dieticians (7{\%}) and dietetic students (2{\%}). Preliminary vignette analysis identified patient and clinician variables influencing motivation to treat, likelihood of addressing weight, and time with the patient The mean IAT score was 0.6854 (95{\%} confidence Intervals 0.6399-0.7309) indicating a strong anti-fat bias.Discussion & conclusion: Our study suggests there may be both patient and clinician variables that impact on effective treatment interventions for clinical management of obese patients.",
keywords = "obesity, clinical decision making, attitudes, Factorial Survey Design, IAT",
author = "Toni McAloon and Donna Fitzsimons and Vivien Coates",
year = "2013",
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}

McAloon, T, Fitzsimons, D & Coates, V 2013, Treating obese patients - what influences our clinical decisions? in Unknown Host Publication. RCN International Nursing Research Conference, 22/03/13.

Treating obese patients - what influences our clinical decisions? / McAloon, Toni; Fitzsimons, Donna; Coates, Vivien.

Unknown Host Publication. 2013.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

TY - GEN

T1 - Treating obese patients - what influences our clinical decisions?

AU - McAloon, Toni

AU - Fitzsimons, Donna

AU - Coates, Vivien

PY - 2013/3/22

Y1 - 2013/3/22

N2 - Background: The obesity pandemic is resulting in premature mortality and increased morbidity and healthcare costs. Prevention is a global health priority but effective management for established obesity is also important. It is known that clinicians often have anti-fat attitudes and assumed that this adversely affects care (Puhl et al 2009). However there is a paucity of research linking anti-fat attitudes to clinical behaviour. Aims: to assess the attitudes of multidisciplinary clinicians to obese individuals and identify variables influencing decision-making.Methods: Online vignettes were generated via a Factorial Survey Design method to assess clinical decision making and were combined with the obesity Implicit Association Test (IAT) to assess subconscious anti-fat bias. Data were collected anonymously from a voluntary convenience sample during 2011-2012 in a virtual research lab managed by Project Implicit®. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to registered nurses and students, medical doctors and students, dieticians and students. Participants used a hyperlink to self-administer eight randomly generated unique vignettes with integrated patient photographs, a demographic questionnaire and the IAT. Vignette responses (n = 3,416) were analysed using Multivariate Regression and the questionnaires by descriptive statistics. The IAT score was calculated from the standardised differences in mean response times on 2 key IAT conditions (Greenwald et al 2003). Results: 427 clinicians participated, 79% being female. Disciplines represented were nurses (38%), student nurses (14%), doctors (19%), medical students (20%), dieticians (7%) and dietetic students (2%). Preliminary vignette analysis identified patient and clinician variables influencing motivation to treat, likelihood of addressing weight, and time with the patient The mean IAT score was 0.6854 (95% confidence Intervals 0.6399-0.7309) indicating a strong anti-fat bias.Discussion & conclusion: Our study suggests there may be both patient and clinician variables that impact on effective treatment interventions for clinical management of obese patients.

AB - Background: The obesity pandemic is resulting in premature mortality and increased morbidity and healthcare costs. Prevention is a global health priority but effective management for established obesity is also important. It is known that clinicians often have anti-fat attitudes and assumed that this adversely affects care (Puhl et al 2009). However there is a paucity of research linking anti-fat attitudes to clinical behaviour. Aims: to assess the attitudes of multidisciplinary clinicians to obese individuals and identify variables influencing decision-making.Methods: Online vignettes were generated via a Factorial Survey Design method to assess clinical decision making and were combined with the obesity Implicit Association Test (IAT) to assess subconscious anti-fat bias. Data were collected anonymously from a voluntary convenience sample during 2011-2012 in a virtual research lab managed by Project Implicit®. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to registered nurses and students, medical doctors and students, dieticians and students. Participants used a hyperlink to self-administer eight randomly generated unique vignettes with integrated patient photographs, a demographic questionnaire and the IAT. Vignette responses (n = 3,416) were analysed using Multivariate Regression and the questionnaires by descriptive statistics. The IAT score was calculated from the standardised differences in mean response times on 2 key IAT conditions (Greenwald et al 2003). Results: 427 clinicians participated, 79% being female. Disciplines represented were nurses (38%), student nurses (14%), doctors (19%), medical students (20%), dieticians (7%) and dietetic students (2%). Preliminary vignette analysis identified patient and clinician variables influencing motivation to treat, likelihood of addressing weight, and time with the patient The mean IAT score was 0.6854 (95% confidence Intervals 0.6399-0.7309) indicating a strong anti-fat bias.Discussion & conclusion: Our study suggests there may be both patient and clinician variables that impact on effective treatment interventions for clinical management of obese patients.

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KW - clinical decision making

KW - attitudes

KW - Factorial Survey Design

KW - IAT

M3 - Conference contribution

BT - Unknown Host Publication

ER -