How missing is a missed opportunity for talk about lifestyle?: Presenter(s): Sarah White, University of New South Wales, Australia

Lifestyle factors including smoking, poor nutrition, alcohol use, and sedentary behaviour are now being recognised as essential targets for early intervention in general practice. Consultations between general practitioners (GPs) and patients provide an opportunity to discuss preventative interventions and risky lifestyle behaviours. However, Australian Health professionals often under utilise the opportunities to provide lifestyle modification advice to patients due to barriers such as trouble with communication, lack of reimbursement, and lack of training. To support a better understanding of how conversations regarding lifestyle risk factors are discussed in general practice, we examine how GPs and patients manage opportunities for lifestyle talk. We used an applied conversation analytic approach to analyse an existing database of 40 English-language general practice consultations recorded in a metropolitan setting in Australia. This involved building a broad collection of potential cues that could prompt lifestyle talk. These were then closely examined to identify the influence of the structural and sequential organisation of the interaction on how lifestyle talk opportunities were managed in practice. Through this close analysis of the interaction, we found that “missed opportunities” for lifestyle talk were more complex than simple coding would have shown. The sequential placement of the lifestyle talk cue influenced how participants managed the interactional implications of the cue and whether they oriented to its degree of “missing-ness” within the consultation. We also observed the influence of the doctor’s role in leading the consultation on how such opportunities were managed. Close analysis of recordings of naturally occurring interactions allowed us to identify different degrees of missing-ness for lifestyle talk cues. This will allow for refinement of approaches to tackling the issues around missed cues and highlights the need for more detailed analysis of naturally occurring interactions in the development of coding schemes.