Goal-oriented care through the eyes of people with chronic conditions

Abstract

Background: The healthcare system is faced by an increase in chronic conditions and multimorbidity. People with chronic conditions (i.e., ‘patients’) are often confronted with an overload of tasks (e.g., medication management, control visits) prescribed by multiple providers to manage their conditions. As a result, they are at risk of fragmented care. A strategy to integrate the different processes might be to explicitly focus on the patients’ personal goals. Goal-oriented care (GOC) reorients care from ‘what is the matter with the patient’ to ‘what matters to the patient’ and specifically addresses patients’ personal goals. However, little is known about GOC. Especially about whether and how patients experience GOC during their primary care visits. The aim of this study is to understand the concept of GOC through the patients’ experiences. 
 Method: Interviews with people with chronic conditions (n=50) were analyzed in two ways. A deductive approach based on the GOC attributes generated in a concept analysis on GOC: goal-elicitation, goal-setting, goal-evaluation, patients’ context, and patients’ needs and preferences. An inductive approach based on a thematic analysis using descriptive phenomenology to identify additional aspects of GOC.
 Results: The phase of goal-elicitation was recognized by participants, whereas goal-setting and goal-evaluation were experienced in lesser extent. Regarding the underpinning attributes, mixed feelings were reported concerning the integration of the patients’ context and the presence of their needs and preferences throughout the care process. The inductive analysis revealed specific attention to informing patients about their condition and treatment options and discussing goals in interprofessional collaboration. 
 Conclusion: Goal-elicitation was already present and seems to be a good foundation for GOC. More attention should be given to goal-setting and goal-evaluation. Developing guidance by means of a workflow, tools, or questions might support people with chronic conditions and providers to underpin the entire care process with the patients’ personal goals.