The Establishing Focus protocol: Training for collaborative agenda setting and time management in the medical interview.

Mauksch, Larry B.; Hillenburg, L.; Robins, Lynne

doi:10.1037/h0089539

Cited by 29 publications

(39 citation statements)

References 43 publications

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“…The findings question the assumption that time pressure or physician anxiety about case difficulty account for lowered rates of solicitation. 15,21 This study is limited by the fact that our principal outcome measure, the Index of Understanding, employs a relatively new instrument without a known sensitivity. It may have been unable to discriminate differences in the understanding levels of physicians who interrupted their patients and those who did not.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] Yet the templates developed for taking a survey of patient concerns sometimes recommend physician activity that would constitute interruption by the Beckman-Frankel definition. 14,15 Further, Beckman and Frankel themselves acknowledge that physician interruption might sometimes help patients formulate their concerns (p. 695). 5 Marvel et al found…”

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confidence: 99%

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The effect of physician solicitation approaches on ability to identify patient concerns

2005

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CONTEXT: Studies showing that physicians often interrupt the patient's opening statement assume that this compromises data collection. OBJECTIVE:To explore the association between such interruptions and physician accuracy in identifying patient concerns. DESIGN:This study replicates the Beckman-Frankel methodology and adds exit interviews to assess physician understanding. The authors audiotaped a convenience sample of 70 encounters and surveyed both parties following the visit.SETTING: A community-based ambulatory clinic. PARTICIPANTS:Internal medicine residents (77%) and attending physicians and their adult, English-speaking patients who were primarily low income and ethnic minority. OUTCOME MEASURE: The Index of Understanding measures patientphysician problem list concordance. It is the percentage of patient problems, obtained on exit, that the physician correctly identifies. RESULTS:In 26% of the visits, patients were allowed to complete their agenda without interruption; in 37% the physicians interrupted; and in 37% no inquiry about agenda was made in the first 5 minutes. Neither physician experience nor their assessment of time pressure or medical difficulty was associated with these rates. Exit interviews showed no significant difference in Index of Understanding between those involving completion of agenda (84.6%) and those involving patient interruption (82.4%) (P =.83). But when the physician did not solicit an agenda, the concordance was 59.2%, significantly lower than either the completion (P =.014) or the interruption group (P =.013). CONCLUSION:Interruption as defined by Beckman-Frankel does not curtail ability to identify patient concerns, but failure to ask for the patient's agenda associates with a 24% reduction in physician understanding.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The effect of physician solicitation approaches on ability to identify patient concerns

2005

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“…Prior observational studies of actual care have demonstrated that agenda pursuit can take a variety of forms [8,16,21,37]. We focused on 'essential elements' [16] involving physicians' questioning strategies for eliciting additional concerns that occurred after patients' presentations of their initial or chief concern.…”

Section: Incidence Of Questionsmentioning

confidence: 99%

“…As a component of patient-centered communication [15,[23][24][25], and ultimately of shared decision making [26], agenda pursuit is now a staple of textbooks on medical interviewing [27][28][29] and is a frequent component of physiciantraining programs [5,18,22,[30][31][32][33][34][35]. It has also been integral to innovations in medical interviewing, such as the 'four-habits model' [26,36] and the 'establishing-focus protocol' [16,21,37]. In addition to reducing the incidence of unmet concerns [2], up-front agenda pursuit is associated with patient satisfaction [14], improved physician understanding of patients' concerns [12], and a decreased incidence of late-emerging concerns [8,38].…”

Section: Introductionmentioning

confidence: 99%

Agenda-setting revisited: When and how do primary-care physicians solicit patients’ additional concerns?

Robinson

Tate

2016

Patient Education and Counseling

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Objective: 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. Methods: 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. Results: 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).Conclusions: Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions. Practice implications: Physicians should increase use of optimized forms of agenda setting.

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“…In patient interviews, novice clinicians often dive prematurely 6 into symptoms and possible diagnoses. A patient-centered approach is more effective and ultimately more efficient, starting with open-ended questions to explore the patient's agenda and view of the illness experience.…”

Section: P3 Mentoring Processmentioning

confidence: 99%

Pursuing Personal Passion:

Phillips

2018

Fam Med

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New researchers often face difficulty finding and focusing research questions. I describe a new tool for research mentoring, the Pursuing Personal Passion (P3) interview, and a systematic approach to help learners organize their curiosity and develop researchable questions aligned with their personal and professional priorities. The learner-centered P3 research interview parallels the patient-centered clinical interview. This paper reviews experience with 27 research mentees over the years 2009 to 2016, using the P3 approach to identify their initial research topics, classify their underlying passions and track the evolution into their final research questions. These researchers usually identified one of three personal passions that provided lenses to focus their research: problem, person, or process. Initial research topics focused on: problem (24%, 6), person (48%, 12) and process (28%, 7). Final research questions evolved into: problem (20%, 5), person (32%, 8) and process (48%, 12). Identification of the underlying passion can lead researchers who start with one general topic to develop it into very different research questions. Using this P3 approach, mentors can help new researchers focus their interests into researchable questions, successful studies, and organized programs of scholarship.

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The Establishing Focus protocol: Training for collaborative agenda setting and time management in the medical interview.

Abstract: providers were more satisfied, perceived more complete problem elicitation and collaborative prioritization.These promising pilot data indicate a need to do an expanded study of the EF protocol. Ideas for research and training are discussed.

Cited by 29 publications

References 43 publications

The effect of physician solicitation approaches on ability to identify patient concerns

The effect of physician solicitation approaches on ability to identify patient concerns

Agenda-setting revisited: When and how do primary-care physicians solicit patients’ additional concerns?

Pursuing Personal Passion:

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