Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis

Autor: Marjan J. Meinders, Marcel G. M. Olde Rikkert, Neeltje P. C. A. Vermunt, Mirjam Harmsen, Glyn Elwyn, Gert P. Westert
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Adult
Male
Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1]
Attitude of Health Personnel
media_common.quotation_subject
Context (language use)
Patient Care Planning
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Terminology
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
Older patients
General Practitioners
Goal setting
Perception
Component (UML)
Humans
Medicine
030212 general & internal medicine
Qualitative Research
Shared decision-making
media_common
Clinical geriatricians
Medical education
lcsh:R5-920
General clinicians
business.industry
030503 health policy & services
Geriatricians
Multimorbidity
Middle Aged
Female
0305 other medical science
Family Practice
business
lcsh:Medicine (General)
Decision Making
Shared
Goals
Research Article
Zdroj: BMC Family Practice, Vol 20, Iss 1, Pp 1-12 (2019)
BMC Family Practice, 20
BMC Family Practice
ISSN: 1471-2296
DOI: 10.1186/s12875-019-0966-z
Popis: Background Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity. Methods Semi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component. Results Sixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes. Conclusions Our study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients. Electronic supplementary material The online version of this article (10.1186/s12875-019-0966-z) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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