Eve Angeline Hood-Medland1,2, Anne E C White3,4, Richard L Kravitz1,2, Stephen G Henry1,2. 1. Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA. 2. University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA. 3. Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA. aecwhite@gmail.com. 4. University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA. aecwhite@gmail.com.
Abstract
BACKGROUND: Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience. METHODS: This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids. Using conversation analysis, we developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discussed. Exploratory quantitative analyses were conducted to assess the relationship of agenda setting and visit opening styles with post-visit measures of both patient experience and physician perception of visit difficulty. RESULTS: We identified 2 visit opening styles representing agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda setting opening styles (open-ended question, patient launch, physician launch). Agenda setting was only performed in 11% of visits and was associated with fewer surprise patient topics than visits without agenda setting (mean (SD) 2.67 (1.66) versus 4.28 (3.23), p = 0.03). CONCLUSIONS: In this study of patients with chronic pain, resident physicians rarely performed agenda setting, whether defined in terms of "agenda eliciting" or "agenda re-framing." Agenda setting was associated with fewer surprise topics. Understanding the communication context and outcomes of agenda setting may inform better use of this communication tool in primary care practice.
BACKGROUND: Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience. METHODS: This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids. Using conversation analysis, we developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discussed. Exploratory quantitative analyses were conducted to assess the relationship of agenda setting and visit opening styles with post-visit measures of both patient experience and physician perception of visit difficulty. RESULTS: We identified 2 visit opening styles representing agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda setting opening styles (open-ended question, patient launch, physician launch). Agenda setting was only performed in 11% of visits and was associated with fewer surprise patient topics than visits without agenda setting (mean (SD) 2.67 (1.66) versus 4.28 (3.23), p = 0.03). CONCLUSIONS: In this study of patients with chronic pain, resident physicians rarely performed agenda setting, whether defined in terms of "agenda eliciting" or "agenda re-framing." Agenda setting was associated with fewer surprise topics. Understanding the communication context and outcomes of agenda setting may inform better use of this communication tool in primary care practice.
Authors: Lawrence A Palinkas; Sarah M Horwitz; Carla A Green; Jennifer P Wisdom; Naihua Duan; Kimberly Hoagwood Journal: Adm Policy Ment Health Date: 2015-09
Authors: Thomas O Staiger; Jeffrey G Jarvik; Richard A Deyo; Brook Martin; Clarence H Braddock Journal: J Gen Intern Med Date: 2005-10 Impact factor: 5.128
Authors: Carolyn S Dewa; Desmond Loong; Sarah Bonato; Nguyen Xuan Thanh; Philip Jacobs Journal: BMC Health Serv Res Date: 2014-07-28 Impact factor: 2.655
Authors: Anne Elizabeth Clark White; Eve Angeline Hood-Medland; Richard L Kravitz; Stephen G Henry Journal: J Gen Intern Med Date: 2021-06-22 Impact factor: 5.128