National guidelines exhort GPs to use brief opportunistic interventions to encourage patients to improve their health behaviours.1–3 A recent trial showed that one such intervention for weight loss was acceptable to patients and doctors, and could effectively reduce population mean weight.4 Although brief interventions have been shown to be successful, GPs report several barriers to their frequent delivery in primary care consultations, citing limited consultation time as a key restriction.5,6 Healthcare professionals are often unsure whether, and how best, to raise the topic of their patients’ weight,7 and there is sparse evidence about how GPs can deliver effective interventions that are acceptable to patients and yet do not take up unnecessary consultation time. In this article the authors examine patient responses during the Brief Interventions for Weight Loss (BWeL) trial, where GPs intervened with consecutively attending patients who were overweight but not consulting for help with weight loss. The brief intervention comprised endorsing, offering, and facilitating a referral to a commercial weight management service (CWMS) free of charge. Following patient response to the offer of a free referral, GPs often entered into negotiation or further explanations, which lengthened consultations.
The aim of this study was to identify patterns of patient responses to the initial announcement of the offer of referral, which displayed that the offer had been well received by the patient, and which could be associated with future action. Conversation analysis (CA) was used to systematically explore and document observable patterns of communication. A leading principle of this method is that talk is systematic and orderly, and can be broken down into a series of actions.8 This enables identification of relationships between conversational patterns and specific outcomes.9 CA has been used to research medical interactions since the early 1980s, and extensive focus has been placed on communication in general practice.9–11 This approach highlights, for example, strategies that a doctor can use to avoid unnecessary prescriptions for antibiotics12 or to encourage patients to raise additional concerns.13 This method can be combined with statistical measures to further illustrate findings.14,15 In this study CA was combined with outcome data regarding CWMS attendance, enabling the researchers to explore relationships between patient responses to the offer of CWMS referral and future action. Early identification of responses that indicate an offer is well received by patients — and is associated with future action — could help GPs to tailor their discussions to avoid unnecessarily lengthy negotiations.
How this fits in
Guidelines encourage doctors to identify patients who are obese and refer them to weight management services. However, doctors fear that such conversations take a long time. In this study of consultation audiorecordings of doctors offering such referrals, it is shown that saying ‘yes’ to an offer does not indicate acceptance, but other responses including saying ‘oh yes’ do. Recognising these could allow doctors to shorten the consultation.