Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Vermunt, Neeltje Petronella Catharina Anna; Harmsen, Mirjam; Westert, Gert P.; Rikkert, Marcel G M Olde; Faber, Marjan J.

doi:10.1186/s12877-017-0534-0

Cited by 80 publications

(96 citation statements)

References 38 publications

(80 reference statements)

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“…Little has been published regarding the extent to which frail older people are involved in care planning. A recent systematic review of collaborative goal setting with older patients with chronic disease found only eight relevant articles on the subject and reported nothing about the level of participant involvement in interventions [17]. However, patient activation (including self-efficacy) has parallels with involvement and a large prospective cohort study found that older people in the UK vary in their levels of activation, with lower levels among depressed, older, retired people with poor health literacy and those who lack social support [18].…”

Section: Discussionmentioning

confidence: 99%

Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

Shiner¹,

Ford²,

Steel³

2018

EJPCH

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Objectives: Care plans may improve health when patients are involved in the care planning process. They are recommended for primary care. This study aimed to identify characteristics of older patients with functional impairment (age ≥75 years with problems completing daily activities) who report having a care plan and who are involved in care planning.Methods: The General Practice Patient Survey (individual-level dataset) 2015-16 in England was analysed. Logistic regression was used to estimate associations between having a care plan and being involved with care planning and age, gender, ethnicity, deprivation, multimorbidity, interpersonal relationship with general practitioner (GP) and other variables, clustered at practice level.Results: Three point five percent of GPPS respondents and 14.4% of older people with functional impairment reported having a care plan; however, only a quarter of the latter were involved with the care planning process. Involvement with care planning was associated with seeing own GP (odds ratio (OR) 1.88, 95% confidence interval (CI)1.48 to 2.38) and factors reflecting a positive interpersonal relationship with the GP, including having confidence in the GP (OR 5.92, CI 2.38 to 14.77). Respondents involved with care planning reported greater confidence in managing their own health.Conclusions: Few older people with functional impairment report having a care plan and fewer report involvement in the care planning process. This may reduce the ability of care plans to deliver health benefits and person-centered care.

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Section: Discussionmentioning

confidence: 99%

Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

Shiner¹,

Ford²,

Steel³

2018

EJPCH

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“…However, engaging older patients with multi-morbidity to actively collaborate with health professionals may be challenging due to their frail health, the changing severity of their diseases, and their complex care needs [2]. Previously, health professionals only to a limited extent have collaborated with patients on what matters to them [2,20].…”

Section: Introductionmentioning

confidence: 99%

Sharing responsibility: municipal health professionals’ approaches to goal setting with older patients with multi-morbidity – a grounded theory study

Oksavik

Kirchhoff

Sogstad

et al. 2020

BMC Health Serv Res

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Background: Recent health policy promoting integrated care emphasizes to increase patients' health, experience of quality of care and reduce care utilization. Thus, health service delivery should be co-produced by health professionals and individual patients with multiple diseases and complex needs. Collaborative goal setting is a new procedure for older patients with multi-morbidity. The aim is to explore municipal health professionals' experiences of collaborative goal setting with patients with multi-morbidity aged 80 and above. Methods: A qualitative study with a constructivist grounded theory approach. In total twenty-four health professionals from several health care services in four municipalities, participated in four focus group discussions. Results: Health professionals took four approaches to goal setting with older patients with multi-morbidity: motivating for goals, vicariously setting goals, negotiating goals, and specifying goals. When 'motivating for goals', they educated reluctant patients to set goals. Patients' capacity or willingness to set goals could be reduced, due to old age, illness or less knowledge about the health system. Health professionals were 'vicariously setting goals' when patients did not express or take responsibility for goals due to adaptation processes to disease, or symptoms as cognitive impairment or exhaustion. By 'Negotiating goals', health professionals handled disagreements with patients, and often relatives, who expected to receive more services than usual care. They perceived some patients as passive or having unrealistic goals to improve health. 'Specifying goals' was a collaboration. Patients currently treated for one condition, set sub-goals to increase health. Patients with complex diseases prioritized one goal to maintain health. These approaches constitute a conceptual model of how health professionals, to varying extents, share responsibility for goal setting with patients. Conclusions: Goal setting for patients with multi-morbidity were carried out in an interplay between patients' varying levels of engagement and health professionals' attitudes regarding to what extents patients should be responsible for pursuing the integrated health services' objectives. Even though goal setting seeks to involve patients in co-production of their health service delivery, the health services´aims and context could restrict this co-production.

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“…Qualitative studies focusing on goal setting practices conclude that practice nurses have difficulty exploring patients' experiences, translating needs, and problems into goals, and making shared decisions about goals and actions (MacDonald, Rogers, Blakeman, & Bower, 2008; van Dillen et al, 2015). This seems to be especially true for goal setting with elderly patients, as elderly people often suffer from multimorbidity and have multi-dimensional goals, which do not focus only on medical aspects, but also on well-being and functioning (Vermunt, Harmsen, Westert, Rikkert, & Faber, 2017).…”

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confidence: 99%

Ascribing patients a passive role: Conversation analysis of practice nurses’ and patients’ goal setting and action planning talk

Lenzen

Stommel

Daniëls

et al. 2018

Research in Nursing & Health

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Within primary care, nurses are expected to set goals and make action plans with patients. However, little information is available on how this is done. The aim of this study is to gain insight into how nurses set goals and action plans with patients. Data were collected from three practice nurses working in elderly care and five patients in the Netherlands. Practice nurse is the term for the home care registered nurse in the Netherlands. Five home visits for which goal setting and action planning were the main agreed‐upon objectives, were video‐recorded and transcribed. We found that explicit goal setting was not observable. However, in 16 episodes, action plans were discussed. Action planning was always initiated by the nurse and was oriented toward offering professional help or assistance in order to solve the patient's problems. In response, patients tended to resist the proposed solutions, with the result that action planning was abandoned. By the nurse proposing professional help, patients were positioned as passive rather than active agents. Our results contribute to the understanding of how nurses’ communicative behavior influences the extent to which patients feel encouraged to actively participate in goal setting/action planning.

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Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review

Cited by 80 publications

References 38 publications

Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

Sharing responsibility: municipal health professionals’ approaches to goal setting with older patients with multi-morbidity – a grounded theory study

Ascribing patients a passive role: Conversation analysis of practice nurses’ and patients’ goal setting and action planning talk

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