Robinson Jeffrey D, Tate Alexandra, Heritage John
Portland State University, Department of Communication, University Center Building, 520 SW Harrison Street, Suite 440, Portland, OR 97201, USA.
University of California, Los Angeles, Department of Sociology, Los Angeles, CA, USA.
Patient Educ Couns. 2016 May;99(5):718-23. doi: 10.1016/j.pec.2015.12.009. Epub 2015 Dec 21.
Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions.
We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses.
Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p<.001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., "Do you have any questions?"), those that were formatted so as to allow for 'concerns' (e.g., "Any other concerns?") were significantly more likely to generate some type of agenda item (Chi(2) (1, N=131)=11.96, p=.001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi(2) (1, N=73)=4.99, p=.025).
Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions.
Physicians should increase use of optimized forms of agenda setting.
征求患者完整的关切事项议程（即“议程设定”）可改善患者的健康状况和满意度，以及医生的时间管理。我们评估医生在提出主要诉求后的议程设定问题的分布、内容和有效性。
我们对407例成人与85名在两个州的46家社区诊所执业的全科医生进行的基层医疗、急症护理就诊的录像带/文字记录进行编码。衡量指标包括医生提问的发生率、语言形式、就诊中的位置、得到回应的可能性以及此类回应的性质。
旨在征求主要关切之外其他关切的医生提问仅出现在32%的就诊中（p<0.001）。与那些沟通形式明确征求“问题”的问题（例如，“你有什么问题吗？”）相比，那些以允许提出“关切”的形式提出的问题（例如，“还有其他关切吗？”）更有可能产生某种类型的议程项目（卡方检验（2）（1，N = 131）= 11.96，p = 0.001），并且在就诊期间“早”与“晚”提出时更频繁地产生议程项目（卡方检验（2）（1，N = 73）= 4.99，p = 0.025）。
议程设定相对较少见。医生提问的沟通形式和位置会影响患者提出额外的关切/问题。
医生应增加使用优化形式的议程设定。
