Best Practices for Patient-Centered Appointment Agenda-Setting

July 25, 2018 - A new study from the Mayo Clinic showed that doctors only spend about 11 seconds listening to a patient during appointment agenda-setting before interrupting the patient with their own viewpoint. These results point to a need to improve active listening on the part of the provider to drive better patient satisfaction.

In the study, researchers investigated how providers elicited a patient’s own appointment agenda and how long it took before the clinician interrupted the patient. Providers ended up asking the patient about her own agenda about one-third (36 percent) of the time, and in those cases only allowed the patient to talk for about 11 seconds before being interrupted.

Primary care clinicians tended to allow the patient to set the agenda more often than specialists. Just under one-half (49 percent) of primary care providers elicited the patient agenda, compared to only 20 percent of specialist providers.

These results point to some considerable pitfalls in the patient-provider interaction. As value-based care has taken hold in healthcare, medical experts have asserted the importance of patient engagement in care. This requires integrating the patient as an equal member of the care team, engaging in shared decision-making, and integrating the patient voice into care.

If providers are truly neglecting to listen to and consider their patients’ preferred appointment agendas, they must consider better patient engagement strategies. Appointment agenda-setting has been tied to more effective use of time during a care encounter, as well as more patient satisfaction and adherence to patient preferences.

Below, PatientEngagementHIT.com outlines the best practices for appointment agenda-setting and provider active listening.

Understanding the basics of agenda-setting

Appointment agenda-setting may appear very simple, requiring providers to simply elicit the different concerns they and the patient want to address during the clinic visit. However, providers must understand the full scope of agenda-setting to apply the strategy to their patient interactions.

Appointment agenda-setting should include five basic questions, according to a paper on the subject published in the Annals of Internal Medicine:

• What are the patient’s main concerns for today?
• What are the clinician’s concerns about this patient?
• What are the patient’s specific requests?
• How much of the patient’s or the doctor’s concerns need to be addressed today, and which ones or parts of ones can be deferred to a subsequent contact?
• What disagreements about priorities exist, and how will they be negotiated?

Medical assistants, nurses, or other patient intake support staff can address some of these concerns, such as the reason for visit, before the treating clinician comes into the room. From there, the treating clinician can ask further questions to determine a course of action, said Annals article authors Laurence H. Baker, PhD, Daniel O’Connell, PhD, and Frederic W. Platt, MD, all from the Institute for Healthcare Communication.

Communication strategies for agenda-setting

Providers should lean on open-ended questions to see the full scope of patients’ medical needs. Some successful agenda-setting phrases include:

• What are the patient’s main concerns today?
• What are the clinician’s concerns?
• What are the patient’s most important tasks?
• What must be attended to, what can be postponed?

It is natural for a provider to feel inclined to begin diagnosing while a patient is still addressing agenda-setting questions, but providers must refrain, according to an appointment agenda-setting guide from Virginia Mason Hospital’s continuing medical education program.

This will not only make the patient feel listened to but will also allow providers to see the entire scope of a patient’s condition. A patient may list an exceptionally troubling concern last in her agenda, but if a provider interrupts at the beginning of the list, she may never be able to address it.

While the patient is setting the agenda, providers need to show the patient that they are listening. Active listening skills, such as making eye contact and nodding to display understanding, will help to reinforce a positive patient-provider interaction.

Using agenda-setting for appointment time management

Once the patient has set her agenda, patient and provider can determine appointment priorities. Patients may come with these priorities prepared, but providers must anticipate that a patient may not begin her agenda list with the concerns that are most pressing to her or to the provider.

Additionally, there may be situations during which patient and provider priorities do not match. A patient may wish to discuss an ache in her shoulder, while the provider may think addressing a rash is more pressing.

This is where the provider can display her medical expertise and explain why addressing the rash is a better use of in-office time, Baker, O’Connell, and Platt explained in their Annals article.

However, the provider should not discount the shoulder pain. Instead, the provider must make a plan to follow up on this concern, either via secure message, phone call, office visit, or specialist referral.

Many providers neglect to set an agenda during an appointment because they believe it will consume too much time. However, research has shown that agenda-setting can help providers prioritize their time and reduces the likelihood of a patient bringing up a significant health issue at the end of an appointment.

Agenda-setting is essential for time management, said Baker, O’Connell, and Platt.

“Sometimes patient discussion becomes tangential during a visit,” the trio wrote. “Clinicians searching for a way to bring the conversation back to a more productive track will find an empathic bridge helpful. It is easier to interrupt a patient and return him or her to the purpose of the visit if we have previously established an agenda and identified the patient’s top priorities.”

Integrating the patient into appointment agenda-setting helps incorporate the patient as a part of the care team. Providers need to work alongside patients to set the appointment agenda to ensure they are addressing issues that impact a patient’s daily life and they are dedicating enough time to each of those concerns.

“Setting the agenda at the beginning of the visit reduces last-minute additions by the patient,” Baker, O’Connell and Platt said. “Sharing responsibility for agenda setting allows the patient to feel respected as a participant in that process. Shared responsibility does not end with the agenda but continues throughout the interaction.”