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Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters

  • Naykky Singh Ospina
  • Kari A. Phillips
  • Rene Rodriguez-Gutierrez
  • Ana Castaneda-Guarderas
  • Michael R. Gionfriddo
  • Megan E. Branda
  • Victor M. Montori
Original Research

Abstract

Background

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.

Objective

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.

Design and Participants

We performed a secondary analysis of a random sample of 112 clinical encounters recorded during trials testing the efficacy of shared decision-making tools.

Main Measures

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.

Key Results

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 encounters, 20%); p = .058. Shared decision-making tools did not affect the likelihood of eliciting the patient’s agenda (34 vs. 37% in encounters with and without these tools; p = .09). In 27 of the 40 (67%) encounters in which clinicians elicited patient concerns, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7–22; range 3 to 234 s). Uninterrupted patients took a median of 6 s (interquartile range 3–19; range 2 to 108 s) to state their concern.

Conclusions

Clinicians seldom elicit the patient’s agenda; when they do, they interrupt patients sooner than previously reported. Physicians in specialty care elicited the patient’s agenda less often compared to physicians in primary care. Failure to elicit the patient’s agenda reduces the chance that clinicians will orient the priorities of a clinical encounter toward specific aspects that matter to each patient.

KEY WORDS

agenda setting patient-centered care patient-physician communication 

Notes

Acknowledgements

The authors would like to acknowledge Jonathan Inselman’s assistance in identifying eligible video encounters for this study.

Compliance with Ethical Standards

This study was approved by the local Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4540_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 12 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Naykky Singh Ospina
    • 1
    • 2
  • Kari A. Phillips
    • 3
  • Rene Rodriguez-Gutierrez
    • 2
    • 4
    • 5
  • Ana Castaneda-Guarderas
    • 6
  • Michael R. Gionfriddo
    • 7
  • Megan E. Branda
    • 8
    • 9
  • Victor M. Montori
    • 2
  1. 1.Division of Endocrinology, Department of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of MedicineRochesterUSA
  3. 3.Mayo Clinic School of MedicineRochesterUSA
  4. 4.Division of Endocrinology, Department of Internal MedicineUniversity Hospital “Dr. Jose E. Gonzalez”, Universidad Autónoma de Nuevo LeonMonterreyMexico
  5. 5.Laboratorio Nacional para el Estudio y Aplicación de la Medicina Basada en Evidencia, Análisis Crítico de la Información Científica y FarmacoeconomíaUniversidad Autónoma de Nuevo LeónMonterreyMexico
  6. 6.Department of Emergency MedicineAventura Hospital and Medical CenterMiamiUSA
  7. 7.Center for Pharmacy Innovation and OutcomesGeisingerForty FortUSA
  8. 8.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  9. 9.Department of Health Sciences Research, Division of Health Care Policy and ResearchMayo ClinicRochesterUSA

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