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

Salter, Charlotte, Shiner, Alice, Lenaghan, Elizabeth, Murdoch, Jamie, Ford, John, Winterburn, Sandra and Steel, Nicholas (2019) Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations. British Journal of General Practice, 69 (684). e479-e488. ISSN 0960-1643

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Background: Establishing 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. Although multimorbidity is now normal in general practice, we know little about how doctors and patient should set goals together. Aim : To determine the key components of the goal-setting process in general practice. Design and setting: In-depth qualitative analysis of goal-setting consultations in three general practices, as part of a larger feasibility trial. Focus groups with participating general practitioners and patients. Method: Activity 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. Focus groups were analysed using thematic analysis. Results: Twenty-two patients and 5 GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative goal-setting; 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. Conclusion: Goal-setting required time and energy for 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.

Item Type: Article
Uncontrolled Keywords: goal-setting,doctor-patient communication,multimorbidity,patient-centred care
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: LivePure Connector
Date Deposited: 17 Jun 2019 11:30
Last Modified: 18 Mar 2020 02:18
DOI: 10.3399/bjgp19X704129

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