During consultations, clinicians rarely ask patients to explain the reasons for their visit, a recent study published online July 2 in the Journal of General Internal Medicine has shown.
"The patient's agenda was elicited in 36% of the clinical encounters," noted Naykky Singh Ospina, MD, from the University of Florida, and colleagues. And, 'among those in which the agenda was elicited, patients were interrupted seven out of ten times, with a median time to interruption of 11 seconds."
According to the authors, patient-centered decision-making is a key feature of quality healthcare. In particular, identifying and understanding the patient's agenda for a visit both improves and facilitates patient-clinician communication, they emphasize.
However, studies have highlighted clinicians' infrequent use of the agenda-setting communication skill. Ospina and colleagues, therefore, set out to assess the prevalence of agenda setting among clinicians in general and specialty practice.
Secondary analysis of a random sample
They aimed to evaluate the frequency of clinical encounters in which clinicians asked patients about their reasons for visiting, and the proportion and timing of clinicians' interruptions. They also wanted to determine how shared decision-making (SDM) tools and the clinical setting affected these outcomes.
The researchers conducted a secondary analysis of a random sample of patient-clinician encounters from trials that evaluated the effect of SDM tools. In their study, they examined a combination of audio and video recordings of consultations between 112 patients and their clinicians; 61 of these encounters were in primary care clinics, and 51 were in specialty care clinics.
In each encounter, the researchers identified whether the clinician elicited the patient's agenda by asking an introductory question, such as, "What can I do for you today?" If the clinician did ask such a problem, the researchers noted whether the clinician went on to interrupt the patient's discourse.
Ospina and colleagues found that clinicians invited patients to put forth their agendas in only 40 (36%) of the 112 clinical encounters. And, in 27 (67%) of these 40 encounters, clinicians interrupted their patients at a median time of 11 seconds (interquartile range, 7 – 22 seconds; range 3 – 234 seconds).
Of the 112 encounters, more primary care clinicians (30/61) than specialty clinicians (10/51) invited patients to share their agendas (49% vs. 20%; P = .058), the authors say.
These findings show that clinicians interrupt patients very early in the patients' opening statements and give patients only a few seconds to share the reasons for their visits. Importantly, the study also highlights the lack of improvement over time in clinicians' soliciting of patients' agendas, Ospina and colleagues say.
For example, in a landmark 1984 study, clinicians in a primary care internal medicine practice interrupted patients in 69% of encounters, with a mean of 18 seconds to interruption. "Further studies should explore the relationship between agenda elicitation and patient experience and outcomes," the authors conclude.