How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care.

Autor:	Berntsen GK; Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway., Gammon D; Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway., Steinsbekk A; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway., Salamonsen A; Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway., Foss N; Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway., Ruland C; Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Fønnebø V; Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2015 Dec 10; Vol. 5 (12), pp. e009403. Date of Electronic Publication: 2015 Dec 10.
DOI:	10.1136/bmjopen-2015-009403
Abstrakt:	Objectives: Patients with complex long-term needs experience multiple parallel care processes, which may have conflicting or competing goals, within their individual patient trajectory (iPT). The alignment of multiple goals is often implicit or non-existent, and has received little attention in the literature. Research Questions: (1) What goals for care relevant for the iPT can be identified from the literature? (2) What goal typology can be proposed based on goal characteristics? (3) How can professionals negotiate a consistent set of goals for the iPT? Design: Document content analysis of health service research papers, on the topic of 'goals for care'. Setting: With the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed. Participants: 70 papers that describe 'goals for care', 'health' or 'the good healthcare process' relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar. Results: We developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient's personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines. Conclusions: Personal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and wide-sweeping attitudinal, organisational and regulatory transformation of care delivery. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
Databáze:	MEDLINE
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