Generalist and subspecialist provider perspectives on using agenda setting with patients after communication skills training.

Abstract

Agenda setting is an evidence-based communication skill that has been shown to support higher patient satisfaction and more efficient clinical encounters. This study investigates the impact of a hospital-wide communication skills program (CSP) on providers' use of agenda setting, factors that may influence agenda setting use, and potential barriers to implementing the skill from the providers' perspective. Following a CSP combining experiential workshops with in-person coaching, participants were invited to complete a survey collecting: 1) demographic information, 2) self-perceived frequency of agenda setting use, and 3) self-perceived barriers to agenda setting use. 308 providers across 25 medical specialties completed the survey and were categorized into specialty groups of primary care, surgical, nonsurgical and emergency medicine/intensive. All specialty groups saw a statistically significant increase in reported frequency of using agenda setting since completing the CSP. However, use of agenda setting before and after CSP varied by specialty group. Commonly identified barriers to use include forgetting to do it, interfering with visit flow, and not fitting with specific visit types. While a provider communication program combining experiential workshop with individual coaching led to increased use of agenda setting for all participants, differences between specialties in perceived relevance and feasibility of using agenda setting were demonstrated to be highly context specific. Specialty-specific and common barriers across all groups may reflect a lack of understanding and/or experience with the potential benefits of agenda setting. Findings imply that there is likely a need to tailor training to the contexts and unique challenges of different specialty groups to better enable them to apply agenda setting in their context. Providers may need help in seeing how agenda setting can fit into their unique practice settings; utilizing post-training coaching and reinforcement could help.