Agenda setting in the clinical encounter: what is it, and is it measureable?

The term agenda setting has been used variably across the healthcare literature, in particular in writings on doctor-patient communication, medical education, and behaviour change. No attempt has yet been made to integrate these different conceptualisations. This impacts both investigation and teaching of this communication skill. The studies in this thesis aim to clarify a conceptual foundation, and to develop a measure of agenda setting, for use in teaching clinicians. A context of long-term condition management was selected. In these clinical encounters clinician and patient agendas naturally intersect and may disagree, and patient participation is essential to effective management. Phase 1 of this thesis involved a structured literature review, and focus group study with clinicians in primary and secondary care to map components of agenda setting. These were refined through a consensus group study involving patients, clinicians, researchers and educators. An integrated model of agenda setting is proposed that adopts new terminology: agenda mapping involves establishing shared focus, and agenda navigation involves tracking natural shifts in focus throughout an interaction. Agenda mapping includes six core domains: (1) identifying patient talk topics, (2) identifying clinician talk topics, (3) agreeing shared priorities, (4) agreeing focus, (5) collaboration, and (6) engagement. Clarifying these domains established a foundation for measurement. Phase 2 of this thesis addresses measurement of agenda mapping. A review of measures confirmed that no existing measure includes all agenda mapping domains. The Evaluation of AGenda mapping skiL Instrument (EAGL-I) was developed, and tested in a study with third year medical students. EAGL-I scores were shown to represent reliable and valid assessment of agenda mapping. Conditions, under which reliable assessment may occur, are also discussed. Educators and researchers now have a tool for use in teaching agenda mapping to clinicians. Further investigation of agenda mapping in long-term condition management may also now progress. Key words: agenda setting, agenda mapping, healthcare communication, motivational interviewing, focusing, measurement, psychometric, teaching, training, education, long term conditions, behaviour chang