How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care
AuthorBerntsen, Gro Karine Rosvold; Gammon, Barbara Deede; Steinsbekk, Aslak; Salamonsen, Anita; Foss, Nina; Ruland, Cornelia; Fønnebø, Vinjar
Design: Document content analysis of health service research papers, on the topic of ‘goals for care’.
Setting: With the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed.
Participants: 70 papers that describe ‘goals for care’, ‘health’ or ‘the good healthcare process’ relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar.
Results: We developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient’s personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines.
Conclusions: Personal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and widesweeping attitudinal, organisational and regulatory transformation of care delivery.