Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns?

Area of Science:

• Medical Communication
• Health Services Research
• Patient-Physician Interaction

Background:

• Soliciting patients' complete agendas, known as agenda setting, can enhance health outcomes, patient satisfaction, and physician time management.
• Effective agenda setting involves physicians asking targeted questions to uncover all patient concerns beyond the chief complaint.

Purpose of the Study:

• To assess the distribution, content, and effectiveness of physicians' agenda-setting questions used after the chief complaint.
• To determine how question format and timing influence patient disclosure of additional concerns.

Main Methods:

• Analysis of 407 videotaped/transcribed primary and acute care visits involving 85 general practice physicians.
• Coding of physician questions for incidence, linguistic format, visit position, and patient response.
• Statistical analysis of the relationship between question type, timing, and patient-generated agenda items.

Main Results:

• Physicians' questions to elicit additional concerns occurred in only 32% of visits.
• Questions formatted to solicit 'concerns' (e.g., 'Any other concerns?') were more effective than those soliciting 'questions' (e.g., 'Do you have any questions?').
• Agenda-setting questions were more effective when posed early in the visit compared to later.

Conclusions:

• Agenda setting is underutilized in clinical practice.
• The communication format and timing of physicians' questions significantly impact patients' willingness to share additional concerns.
• Optimizing agenda-setting questions can improve patient-physician communication and comprehensive care.