Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention
1 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
2 Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD, USA
3 The Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
4 The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA
5 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
6 Pacific Business Group on Health, San Francisco, CA, USA
BMC Medical Education 2008, 8:3 doi:10.1186/1472-6920-8-3Published: 14 January 2008
Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.
Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.
There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.
A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.