Collaborative goal-setting: stakeholders’ experiences, barriers and facilitators.
Summary
Background:
Goal-setting is an approach that encourages the use of self-defined goals of care in the process of
decision-making. It is already a commonly known concept in rehabilitation and end-of life care.
Several positive effects have been listed in previous research. At University Medical Center
Utrecht it appears that only few doctors document goals of care in patient records. This study
aims to identify stakeholders’ experiences with goal-setting and the barriers and facilitators to
discussing, documenting and using goals of care in individual health care.
Methods:
A qualitative study design was used. In-depth topic-interviews were held with 19 healthcare
professionals (HCPs) and 7 patients.
Results:
Although the majority of HCPs and patients share a positive attitude towards goal-setting, it
appears hard to accomplish. This study identified that that most HCPs are not consistent in
discussing values, preferences and goals with their patients. Many different barriers to goalsetting are identified, including the ambiguity concerning the interpretation of goals,
organisational barriers, patient-related barriers and the uncertainty about the usefulness and
feasibility of goal-setting in every setting or situation. Most stakeholders agree that the current
methods of goal-setting are not adequate.
Conclusion:
Based on our findings, the formulation of purely medical goals might be useful to improve
communication between HCPs and provide clarity to patients. However, purely medical goals
attribute less to performing care that is person-centered. Further research is recommended to
identify ways to overcome the barriers and to develop a strategy for meaningful goal-setting in
different care settings.