Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain

Autor: Richard L. Kravitz, Eve Angeline Hood-Medland, Stephen G. Henry, Anne Elizabeth Clark White
Rok vydání: 2021
Předmět:
medicine.medical_specialty
conversation analysis
Conversation analysis
Office Visits
media_common.quotation_subject
Coding (therapy)
Chronic pain
Context (language use)
Nursing
01 natural sciences
doctor-patient communication
primary care
03 medical and health sciences
0302 clinical medicine
agenda setting
Patient experience
medicine
Humans
030212 general & internal medicine
0101 mathematics
health care economics and organizations
media_common
Mixed-methods
Physician-Patient Relations
lcsh:R5-920
Primary Health Care
Physician-patient communication
business.industry
Communication
010102 general mathematics
social sciences
Cognitive reframing
Primary care
medicine.disease
humanities
Analgesics
Opioid
Surprise
Agenda setting
Opioid analgesics
Family medicine
Public Health and Health Services
Observational study
Public Health
lcsh:Medicine (General)
Family Practice
business
Research Article
Zdroj: BMC Family Practice, Vol 22, Iss 1, Pp 1-11 (2021)
BMC Family Practice
BMC Family Practice, vol 22, iss 1
BMC family practice, vol 22, iss 1
ISSN: 1471-2296
DOI: 10.1186/s12875-020-01317-4
Popis: 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.
Databáze: OpenAIRE
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