Taxonomy and effectiveness of clinician agenda-setting questions in routine ambulatory encounters: A mixed method study

Objectives: Despite decades of communication training, studies repeatedly demonstrate that clinicians fail to elicit patients’ agendas. Our goal was to provide clinicians with actionable guidance about the effectiveness of agenda-soliciting questions. Methods: We coded clinician agenda-soliciting questions and patient responses in audio-recorded ambulatory encounters at an urban academic hospital. To evaluate the association between question type and odds of the patient raising a concern, we performed mixed-effects logistic regression. Results: We identified 346 agenda-soliciting questions within 138 visits (mean 2.51/visit; range 0–9). Agenda-soliciting questions were categorized as personal state inquiries (37%, “How are you?”), feeling-focused (5% “How're you feeling?”), problem-focused (12%; “Are you having any problems”), direct solicitations (3%; “Anything you want to discuss today?”), “what else” (3%), “anything else” (14%), leading (16%; “Nothing else today?”), and space-reducing (11% “Anything else? Smoking?”). Patients raised a concern in response to 107 clinician questions (27%). Patients were more likely to raise a concern to direct solicitation (OR 22.95, 95% CI 2.62–200.70) or “what else” (OR 4.68, 95% CI 1.05–20.77) questions. Conclusions: The most effective agenda-soliciting questions are used least frequently by clinicians. Practice implications: Clinicians should elicit patient agendas by using direct language, and solicit additional concerns using “what else” vs. “anything else” questions.