Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

Abstract

BackgroundEstablishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together.AimTo determine the key components of the goal-setting process in general practice.Design and settingIn-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018.MethodActivity analysis was applied to 10 hours of video-recorded doctor–patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis.ResultsA total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient.ConclusionGoal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals. Goal setting worked best when both GP and patient were prepared in advance.

Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers

“…The findings on interference of mental disorders with treatment adherence for other chronic conditions also exemplifies previous descriptions [69,70]. The importance of illness acceptance and an individualised approach to patients in communication and care planning, echoes previous postulates for exploration of personal meaning of health [33,71]; adoption of a broader care strategy inclusive of pluralistic and personalised capabilities [72][73][74]; and treatment initiation through elicitation of personal motives for change through selfreflection and provision of individualized information [9,16,[33][34][35]75].…”

“…Addressing this gap in evidence could inform solutions to common problems in management of MM in Brazilian PHC. The ultimate goal is to inform healthcare providers (HCP) how to effectively coordinate MM care, while incorporating individual patient priorities and preferences in personalized treatment plans for MM patients [33][34][35].…”

Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial

“…Goal-setting consultations were more focused on what matters to the patient than the control consultations. Key challenges in goal-setting included preparation and agreeing goals and we explore these further elsewhere 32. Some patients were concerned that their goals were not considered in future consultations, which suggests that better communication of goals with the rest of the healthcare team will be needed.…”

“…The video and audio recordings of control and goal-setting consultations were compared by the research team (CS, EL, AS, JM and Rebecca Harmston (RH)) to measure duration and explore the content and methodological implications for a future study. An in-depth analysis of the consultations using a conversation analytic informed approach31 is reported elsewhere 32…”

Goal-setting with patients with multi-morbidity

“…Many methods involving goal-setting have been described, and one of the simplest of these is Goal Attainment Scaling (GAS), as described by Turner-Stokes (2019). A recent study has shown that the use of a goal-setting tool developed from GAS for use in primary care is feasible and effective in consultations with patients with multi-morbidity (Ford et al., 2019; Salter et al., 2019). Box 1 outlines the modified version of GAS that was used by GPs and patients in this study.…”