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

Abstract

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.

Information and Communications Technologies Enabling Integrated Primary Care for Patients With Complex Care Needs: Scoping Review

“…System-level integration and the normative aspect of integration were absent in the sample of studies in this review. Undertaking an ICT-enabled system integration can be challenging because of interoperability issues, provider unwillingness, lack of coalition among stakeholders, lack of data privacy, and security issues [ 84 , 85 ]. For future researchers, it would be important to explore the broader system-level changes that are required for the successful adoption and implementation of ICTs in the integrated primary care model.…”

Seeking Choice to Fulfill Health Literacy Needs: Health Literacy Opportunities for Consumers in Hospital Waiting Areas

“…New and existing data were compared and reintegrated to refine the theoretical concepts (Walder & Molinaeux, 2020). Thirdly, theoretical coding was used to create a conceptual model (Oksavik et al, 2020). Theoretical memos and diagrams were used to explore the properties of and relationships between the developing codes, categories, and substantive theory (Charmaz & Thornberg, 2020).…”

Introduksjon

“…Det skal skje ved at tiltak som iverksettes, bygger på at bruker setter egne mål sammen med faglig personell, som dermed må endre sine arbeidsrutiner. Dette representerer også endring i relasjonen og kommunikasjonen mellom bruker og ansatt, blant annet gjennom vektlegging av å utforske, forstå, avdekke og forbedre (Little et al, 2001;Oksavik, et al, 2020). Andreassen (2018) viser til at når målgruppen er enkeltindivider og man har som formål å styrke posisjonen til den enkelte, vil en rekke av tiltakene som tas i bruk, vaere av typen «konsument» og strategiske «valg».…”