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BMC Primary Care
Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Research article

Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis

Authors: Neeltje Vermunt, Glyn Elwyn, Gert Westert, Mirjam Harmsen, Marcel Olde Rikkert, Marjan Meinders

Published in: BMC Primary Care | Issue 1/2019

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Abstract

Background

Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity.

Methods

Semi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component.

Results

Sixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes.

Conclusions

Our study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients.
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Metadata
Title
Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis
Authors
Neeltje Vermunt
Glyn Elwyn
Gert Westert
Mirjam Harmsen
Marcel Olde Rikkert
Marjan Meinders
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-0966-z

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