Taxonomy and effectiveness of clinician agenda-setting questions in routine ambulatory encounters: A mixed method study.
Sean Allgood, Jenny Park, Kiana Soleiman and 5 others
PMID 37480792WHAT IT FOUND
Direct questions like 'What do you want to address?' and 'What else?' were much more likely to be followed by a patient raising a concern than 'How are you?' Leading questions were less likely.
Key findings
01Patients had 22-fold greater odds of raising a discussion item after direct agenda-soliciting questions, and more than 4-fold greater odds after 'what else' questions, compared with personal state inquiries.
02Leading questions were associated with 78% lower odds of patients raising a discussion item than personal state inquiries, both before and after adjusting for question timing.
03Direct solicitations and 'what else' questions each made up 3% of the 395 agenda-soliciting questions, while personal state inquiries made up 37%.
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 in HIV ambulatory care at one academic medical center, so it may not apply to other clinics or patient groups. The effective question types were rare, so the exact size of their association is uncertain. Researchers used audio transcripts only, so tone, gestures, pauses, and non-verbal cues were not considered. The study did not check whether patients brought up concerns without being asked, or whether patients felt all concerns were met. This was an observational study, not a trial, so it shows association with patient responses, not that the questions caused better care. Participants were mostly physicians and nurse practitioners, so it may not reflect PT, OT, or SLP encounters.
Declared interests
The supplied metadata lists NIH extramural research support. The article text provided does not include a conflicts of interest declaration.
The easy way to misread this
Do not read the 22-fold greater odds as proof that changing one question will improve care. The study observed associations in HIV primary care visits, and direct questions were rare.