Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns? (original) (raw)
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Health Communication, 2015
In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with "unmet" concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients' health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known as up-front agenda setting, where physicians (after soliciting patients' chief concerns) continue to solicit patients' concerns to "exhaustion" with questions such as "Are there some other issues you'd like to address?" Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant "new problems" (i.e., concerns that are either totally new or "new since last visit," and in need of diagnosis), and consequently bias answers away from "non-new problems" (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians.
Physicians' opening questions and patients' satisfaction
Objective: To determine the association between the format of physicians' opening questions that solicit patients' presenting concerns and patients' post-visit evaluations of (i.e., satisfaction with) the affective-relational dimension of physicians' communication. Methods: Videotape and questionnaire data were collected from visits between 28 primary-care physicians and 142 adult patients with acute problems. Factor analysis resulted in three dependent variables derived from the 9-item Socioemotional Behavior subscale of the Medical Interview Satisfaction Scale. Results: Question format was significantly, positively associated with patients' evaluations of physicians' listening (p = .028) and positive affective-relational communication (p = .046). Conclusion: Patients desire opportunities to present concerns in their own time and terms regardless of how extensively they act on this opportunity. Practice implications: Visits should be opened with general inquiries (e.g., What can I do for you today?) versus closed-ended requests for confirmation (e.g., Sore throat, huh?).
When patients visit primary-care physicians, they frequently have more than one concern. Patients' first concerns are solicited by physicians at the beginnings of encounters. A challenge to health care is how to get patients' additional concerns raised as topics of discussion. If patients' additional concerns are addressed, it tends to occur at the end of encounters. Using the methodology of conversation analysis, this article identifies and describes the interactional organization of two physician-initiated communication practices that are used to negotiate the closure of the business of encounters and a transition into the activity of closing encounters themselves. These practices have different implications for the topicalization of patients' additional concerns. #
Accomplishing a request without making one: A single case analysis of a primary care visit.
Physicians and other care-givers need to recognize the various and often subtle ways that patients make initiatives, such as requesting medical interventions, in medical encounters. Prior research on patients' requests and physicians' responses has limited real-world relevance because it treats `requesting' and `responding' as straightforward, discretely codable categories. In this study, we use conversation analysis to investigate how a primary care patient delicately hints that an HIV test is warranted and how her physician recognizes (and responds to) her implicit request for this diagnostic test. Our findings provide an empirically grounded and detailed account of some of the subtle interactional dynamics involved in making and responding to medical requests. By documenting the diversity of patients' and physicians' practices, we will gain a more comprehensive understanding of patients' initiatives, physicians' responsiveness, and patient-centered behavior.
Eliciting the Patient's Agenda- Secondary Analysis of Recorded Clinical Encounters
Journal of general internal medicine, 2018
Eliciting patient concerns and listening carefully to them contributes to patient-centered care. Yet, clinicians often fail to elicit the patient's agenda and, when they do, they interrupt the patient's discourse. We aimed to describe the extent to which patients' concerns are elicited across different clinical settings and how shared decision-making tools impact agenda elicitation. We performed a secondary analysis of a random sample of 112 clinical encounters recorded during trials testing the efficacy of shared decision-making tools. Two reviewers, working independently, characterized the elicitation of the patient agenda and the time to interruption or to complete statement; we analyzed the distribution of agenda elicitation according to setting and use of shared decision-making tools. Clinicians elicited the patient's agenda in 40 of 112 (36%) encounters. Agendas were elicited more often in primary care (30/61 encounters, 49%) than in specialty care (10/51 encou...
Objective To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. Summers, R.H., Michael, M., Ekberg, S., Chew-Graham, C.A, Little, P., Stevenson, F., Brindle, L. & Leydon, G.M. Methods Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. Results Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. Conclusion The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. Practice implications Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.