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Background: Although studies have demonstrated that physicians often fail to elicit the full spectrum of patient concerns, few studies have described the ways in which physicians elicit concerns and the extent to which they set an explicit agenda.
Methods: We performed a qualitative analysis of audio recorded, transcribed routine patient-provider encounters from the Enhancing Communication and HIV Outcomes (ECHO) Study. We developed themes related to whether and how providers elicit patient concerns and then set an agenda for the visit. We developed a coding scheme that we applied to a random selection of 2 encounters per provider (33 providers, 66 encounters total).
Findings: In 41/66 encounters, providers opened the visit with a general question (“How are you doing?”). Seven visits opened with a leading question (“Everything’s okay?”) and 1 with the provider explicitly asking which concerns s/the patient wanted to discuss. Patients more often responded to these opening questions with brief positive statements (“Fine”, n=30) than with actual concerns (n=14). In 12 encounters (18%), the provider continued to elicit concerns until the patient stated that s/he had no further concerns (probe to exhaustion). In 30 encounters, there was no agenda statement. When an agenda statement was made, it most often (n=20) centered on physicians’ priorities. Rarely, there was an agenda statement made by the patient (n=3) or one that was collaboratively negotiated (n=3). In 53% of encounters (n=35), patients brought up new concerns later in their visit.
Implications: Providers frequently use generic opening questions that may not be effective in eliciting patients’ concerns, and then do not continue to elicit further concerns. Negotiation of the visit agenda is rare, and new concerns continue to arise later in most encounters. Providers need further training to more effectively invest in the beginning of each encounter.
Word Count 293
KEY WORDS HIV - communication - decision-making preferences