title: Describing the factors that influence the process of making a shared-agenda in Japanese family physician consultations: a qualitative study.
abstract: BACKGROUND
  Patients cannot always share all necessary relevant information with doctors during medical consultations. Regardless, in order to ensure the best quality consultation and care, it is imperative that a doctor clearly understands each patient's agenda. The purpose of this study was to analyze the process of developing a shared-agenda during family physician consultations in Japan.
  
  
  METHODS
  We interviewed 15 first time patients visiting the outpatient clinic of the Department of Family Medicine in the hospital chosen for the investigation, and the 8 family physicians who examined them. In total we observed 16 consultations. We analyzed both patients' and doctors' narratives using a modified grounded theory approach.
  
  
  RESULTS
  For patients, we found four main factors that influenced the process of making a shared-agenda: past medical experiences, undisclosed but relevant information, relationship with the family physician, and the patient's own explanatory model. In addition, we found five factors that influenced the shared agenda making process for family physicians: understanding the patient's explanatory model, constructing the patient-doctor relationship, physical examination centered around the patient's explanatory model, discussion-styled explanation, and self-reflection on action.
  
  
  CONCLUSIONS
  The findings suggest that patient satisfaction would be increased if family physicians are proactive in considering these factors with respect to both the patient's agenda, and their own.
authors.affiliation: Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Goto
authors.affiliation: Community-based Medicine Education Station kitaibaraki, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokoya
authors.affiliation: Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan ; Department of Family Medicine, Mie University School of Medicine & Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Takemura
authors.affiliation: Center for Medical and Nursing Education, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan.
authors.forename: Alberto Alexander
authors.initials: AA
authors.lastname: Gayle
authors.affiliation: Kikugawa municipal Family Medicine Center, 1055-1 Akatsuti, Kikugawa, Shizuoka 439-1507 Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tsuda
keywords: Agenda-sharing; Communication; Doctor-patient relationship; Patient’s explanatory model; Taking a medical history