"It helps us say what's important..." Developing Serious Illness Topics: A clinical visit agenda-setting tool.
Catherine H Saunders, Marie-Anne Durand, Peter Scalia and 9 others
PMID 37150152WHAT IT FOUND
Patients and families said an agenda-setting tool helped them bring priorities into serious illness visits; clinicians said it shaped conversations and prompted topics they might otherwise miss.
Key findings
01Most patients and families appreciated the agenda-setting concept because they thought it would encourage a more active role in visits and help them know what to ask.
02In preliminary testing, patients and families said the guide helped focus visits on their priorities, and patients with the lowest incomes also found it useful.
03Clinicians reported that the guide helped patients organize thoughts, made patient priorities clear, changed visit flow so patients could raise concerns first, and prompted topics they otherwise would not have asked about.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one health system in an area with low racial and ethnic diversity, so it may not fit more diverse populations. The preliminary testing included 12 pilot visits with 11 patients and 12 family members, and it measured perceptions, distress, disruption, and confusion rather than visit length, patient outcomes, or serious illness experience. Participants may have answered positively because they wanted to please the researchers, although the researchers tried to separate themselves from the care teams. The interview guide was not piloted before use. The researchers did not ask interviewees to confirm the themes or return transcripts for review. Some survey percentages did not sum to 100 because participants skipped questions. Three patients and three family members did not wish to participate, and two participants did not complete interviews because of fatigue or mental health issues.
Declared interests
The supplied text does not include a conflicts-of-interest declaration. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that the agenda-setting tool has been shown to improve visit length, patient outcomes, or serious illness experience. This was tool development and preliminary pilot testing, not a trial of effectiveness.