Abstract

BackgroundGoal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment.MethodsThe study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician).ResultsJust over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required.ConclusionsThe data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice.

Highlights

  • Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions

  • The two research questions addressed are: 1) “What are patient goals of care from the perspectives of older adults with multi-morbidities, their caregivers and family physicians? 2) “Do patient goals of care align among patient-caregiver and family physician triads?” Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad

  • Goal setting in clinical care is recommended as a means to support individuals with multi-morbidities and their caregivers in managing their conditions

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Summary

Introduction

Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. The types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. A setting where much chronic disease management takes place, has been a focal point for reform across industrialized healthcare systems; showing potential in improving patient health outcomes [5] and alleviating strain on hospitals and emergency departments [6]. Key to the success of primary care is addressing the unique needs of each patient and providing them, and their family caregivers with the tools to manage their illnesses. Understanding patient’s goals of care can potentially aid in the successful management of their diseases at home [11] and when integrated into care plans, can improve their quality of life [12]

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